• Brendan FitzgeraldEmail author


Placental infarction is defined as an area of ischaemic coagulative necrosis of the placental parenchyma. It is one of the most common lesions identified during pathological examination of the placenta and is a key pathological marker of maternal vascular malperfusion. It is a common placental finding in some of the most important complications of pregnancy, including preeclampsia, fetal growth restriction and pregnancy loss.

In this chapter the gross appearance of placental infarction is described, and an outline is provided of the microscopic features seen in infarcts of varying age.


Placental infarction Villous infarction Infarction haematoma Rounded intraplacental haematoma Maternal vascular malperfusion Preeclampsia Fetal growth restriction 


  1. 1.
    Brosens I, Pijnenborg R, Vercruysse L, Romero R. The "Great Obstetrical Syndromes" are associated with disorders of deep placentation. Am J Obstet Gynecol. 2011;204:193–201.CrossRefGoogle Scholar
  2. 2.
    Becroft DM, Thompson JM, Mitchell EA. The epidemiology of placental infarction at term. Placenta. 2002;23:343–51.CrossRefGoogle Scholar
  3. 3.
    Mousa HA, Alfirevic Z. Do placental lesions reflect thrombophilia state in women with adverse pregnancy outcome? Hum Reprod. 2000;15:1830–3.CrossRefGoogle Scholar
  4. 4.
    Moldenhauer JS, Stanek J, Warshak C, Khoury J, Sibai B. The frequency and severity of placental findings in women with preeclampsia are gestational age dependent. Am J Obstet Gynecol. 2003;189:1173–7.CrossRefGoogle Scholar
  5. 5.
    Nelson DB, Ziadie MS, McIntire DD, Rogers BB, Leveno KJ. Placental pathology suggesting that preeclampsia is more than one disease. Am J Obstet Gynecol. 2014;210:66.e1–7.CrossRefGoogle Scholar
  6. 6.
    Mifsud W, Sebire NJ. Placental pathology in early-onset and late-onset fetal growth restriction. Fetal Diagn Ther. 2014;36:117–28.CrossRefGoogle Scholar
  7. 7.
    Bartsch E, Medcalf KE, Park AL, Ray JG. High Risk of Pre-eclampsia Identification Group. Clinical risk factors for pre-eclampsia determined in early pregnancy: systematic review and meta-analysis of large cohort studies. BMJ. 2016;353:i1753.CrossRefGoogle Scholar
  8. 8.
    Fitzgerald B, Shannon P, Kingdom J, Keating S. Rounded intraplacental haematomas due to decidual vasculopathy have a distinctive morphology. J Clin Pathol. 2011;64:729–32.CrossRefGoogle Scholar
  9. 9.
    Neville G, Russell N, O’Donoghue K, Fitzgerald B. Rounded Intraplacental Haematomas–a high risk placental lesion as illustrated by a prospective study of 26 consecutive cases. Presentation, Society for Pediatic Pathology Spring Meeting, San Antonio, 2017.Google Scholar
  10. 10.
    Bendon RW. Nosology: infarction hematoma, a placental infarction encasing a hematoma. Hum Pathol. 2012;43:761–3.CrossRefGoogle Scholar
  11. 11.
    Fox H, Laurini RN. Intraplacental choriocarcinoma: a report of two cases. J Clin Pathol. 1988;41:1085–8.CrossRefGoogle Scholar
  12. 12.
    Battinelli EM, Marshall A, Connors JM. The role of thrombophilia in pregnancy. Thrombosis. 2013;2013:516420.CrossRefGoogle Scholar
  13. 13.
    Simcox LE, Ormesher L, Tower C, Greer IA. Thrombophilia and pregnancy complications. Int J Mol Sci. 2015;16:28418–28.CrossRefGoogle Scholar
  14. 14.
    Jebbink J, Wolters A, Fernando F, Afink G, van der Post J, Ris-Stalpers C. Molecular genetics of preeclampsia and HELLP syndrome–a review. Biochim Biophys Acta. 1822;2012:1960–9.Google Scholar
  15. 15.
    Haram K, Mortensen JH, Nagy B. Genetic aspects of preeclampsia and the HELLP syndrome. J Pregnancy. 2014;2014:910751.CrossRefGoogle Scholar
  16. 16.
    Ahmed R, Dunford J, Mehran R, Robson S, Kunadian V. Pre-eclampsia and future cardiovascular risk among women: a review. J Am Coll Cardiol. 2014;63:1815–22.CrossRefGoogle Scholar
  17. 17.
    Vedmedovska N, Rezeberga D, Teibe U, Melderis I, Donders GG. Placental pathology in fetal growth restriction. Eur J Obstet Gynecol Reprod Biol. 2011;155:36–40.CrossRefGoogle Scholar
  18. 18.
    Veerbeek JH, Nikkels PG, Torrance HL, Gravesteijn J, Post Uiterweer ED, Derks JB, et al. Placental pathology in early intrauterine growth restriction associated with maternal hypertension. Placenta. 2014;35:696–701.CrossRefGoogle Scholar
  19. 19.
    Stanek J. Comparison of placental pathology in preterm, late-preterm, near-term, and term births. Am J Obstet Gynecol. 2014;210:234.e1–6.CrossRefGoogle Scholar
  20. 20.
    Nijman TA, van Vliet EO, Benders MJ, Mol BW, Franx A, Nikkels PG, et al. Placental histology in spontaneous and indicated preterm birth: A case control study. Placenta. 2016;48:56–62.CrossRefGoogle Scholar
  21. 21.
    Opsjøn BE, Vogt C. Explaining fetal death–what are the contributions of fetal autopsy and placenta examination? Pediatr Dev Pathol. 2016;19:24–30.CrossRefGoogle Scholar
  22. 22.
    Kidron D, Bernheim J, Aviram R. Placental findings contributing to fetal death, a study of 120 stillbirths between 23 and 40 weeks gestation. Placenta. 2009;30:700–4.CrossRefGoogle Scholar
  23. 23.
    Bukowski R, Hansen NI, Pinar H, Willinger M, Reddy UM, Parker CB, et al. Altered fetal growth, placental abnormalities, and stillbirth. PLoS One. 2017;12:e0182874.CrossRefGoogle Scholar
  24. 24.
    Korteweg FJ, Gordijn SJ, Timmer A, Holm JP, Ravisé JM, Erwich JJ. A placental cause of intra-uterine fetal death depends on the perinatal mortality classification system used. Placenta. 2008;29:71–80.CrossRefGoogle Scholar
  25. 25.
    Blair E, de Groot J, Nelson KB. Placental infarction identified by macroscopic examination and risk of cerebral palsy in infants at 35 weeks of gestational age and over. Am J Obstet Gynecol. 2011;205:124.e1–7.CrossRefGoogle Scholar
  26. 26.
    Redline RW, Minich N, Taylor HG, Hack M. Placental lesions as predictors of cerebral palsy and abnormal neurocognitive function at school age in extremely low birth weight infants (<1 kg). Pediatr Dev Pathol. 2007;10:282–92.CrossRefGoogle Scholar
  27. 27.
    Joss-Moore LA, Lane RH. The developmental origins of adult disease. Curr Opin Pediatr. 2009;21:230–4.CrossRefGoogle Scholar
  28. 28.
    Barker DJ. Adult consequences of fetal growth restriction. Clin Obstet Gynecol. 2006;49:270–83.CrossRefGoogle Scholar
  29. 29.
    Andescavage NN, du Plessis A, Limperopoulos C. Advanced MR imaging of the placenta: exploring the in utero placenta-brain connection. Semin Perinatol. 2015;39:113–23.CrossRefGoogle Scholar
  30. 30.
    Alkazaleh F, Viero S, Simchen M, Walker M, Smith G, Laskin C, et al. Ultrasound diagnosis of severe thrombotic placental damage in the second trimester: an observational study. Ultrasound Obstet Gynecol. 2004;23:472–6.CrossRefGoogle Scholar
  31. 31.
    Lo J, Roberts V, Schabel M, Wang X, Morgan T, et al. Novel detection of placental insufficiency by MRI in the nonhuman primate. Reprod Sci. 2018;25:64–73.CrossRefGoogle Scholar
  32. 32.
    Toal M, Chaddha V, Windrim R, Kingdom J. Ultrasound detection of placental insufficiency in women with elevated second trimester serum alpha-fetoprotein or human chorionic gonadotropin. J Obstet Gynaecol Can. 2008;30:198–206.CrossRefGoogle Scholar
  33. 33.
    Wright D, Akolekar R, Syngelaki A, Poon LC, Nicolaides KH. A competing risks model in early screening for preeclampsia. Fetal Diagn Ther. 2012;32:171–8.CrossRefGoogle Scholar
  34. 34.
    Roberge S, Nicolaides K, Demers S, Hyett J, Chaillet N, Bujold E. The role of aspirin dose on the prevention of preeclampsia and fetal growth restriction: systematic review and meta-analysis. Am J Obstet Gynecol. 2017;216:110–20.CrossRefGoogle Scholar
  35. 35.
    McLaughlin K, Scholten RR, Parker JD, Ferrazzi E, Kingdom JCP. Low molecular weight heparin for the prevention of severe preeclampsia: where next? Br J Clin Pharmacol. 2018;84:673–8.CrossRefGoogle Scholar
  36. 36.
    Paauw ND, Terstappen F, Ganzevoort W, Joles JA, Gremmels H, Lely AT. Sildenafil during pregnancy: A preclinical meta-analysis on fetal growth and maternal blood pressure. Hypertension. 2017;70:998–1006.CrossRefGoogle Scholar
  37. 37.
    Khong TY, Ting M, Gordijn SJ. Placental pathology and clinical trials: Histopathology data from prior and study pregnancies may improve analysis. Placenta. 2017;52:58–61.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of PathologyCork University HospitalCorkIreland
  2. 2.Department of PathologyUniversity College CorkCorkIreland

Personalised recommendations