Outcome and follow-up
The team decided to induce the labor at 35 weeks and 2 days, by vaginal prostin E2 tablets. Labour was uncomplicated and a healthy girl of 2160 g and 46 cm, Apgar score 8-9-10, born the day after. The placenta was delivered spontaneously.
The female infant was admitted to the neonatal unit due to induced prematurity.
The adaptation to extrauterine life went smoothly. A transitory hypoglycemia was noted as well as a neonatal jaundice requiring phototherapy. No anemia and no thrombocytopenia were detected.
The placenta was sent for pathological examination. The macroscopic report found the placenta to be enlarged and thickened, weighing 530g (90th percentile). Near cord insertion on the fetal surface, vessels were dilated, tortuous with varicose like aspect and abnormal branching (Figure 3, left). A fibrinoid deposition was found on one third of the maternal surface. On the cut sections, organized thrombi were found in the macroscopically dilated vessels that also exhibited a microscopically thickened wall. Histological examination found enlarged villi with cisterns with hypercellularity and stromal fibrosis (Figure 3, right). No trophoblastic proliferation nor stromal trophoblastic inclusions were found. Therefore, a PMD diagnosis was established with certainty after pathologic examination. Additionally, only a limited portion of the placenta did not exhibit any histological abnormality, showing typical aged matched terminal villi.