CLINICAL-SIGNIFICANCE AND TREATMENT OF MASSIVE INTERVILLOUS FIBRIN DEPOSITION ASSOCIATED WITH RECURRENT FETAL GROWTH-RETARDATION

Retrospective examinations of 8,139 placentae were performed to clarif y the relationship between placental disorders with massive intervillo us fibrin deposition (MIFD) and intrauterine growth retardation (IUGR) . Although the incidence of MIFD was low (0.4%), the small-for-date (S FD) birth rate in the MIFD group was significantly higher than that in the control group (62.9 vs. 8.3%; p < 0.001). Seventeen of 35 patient s in the MIFD group had no clinical complications. MIFD itself was tho ught to be the main cause of IUGR in these patients. 78.4% of multipar ae in the MIFD group gave unsuccessful obstetrical histories such as i ntrauterine fetal death and fetal growth retardation. Four of 6 patien ts with a history of MIFD and SFD delivery in a previous pregnancy rep eated the same episode. These data indicate the MIFD recurrence rate i n subsequent pregnancies must be high. Patients with a history of both SFD delivery and MIFD in previous pregnancies were defined as high-ri sk patients and they were given orally 30 mg of aspirin and 150 mg of dipyridamole daily and/or daily intravenous injection of 10,000 IU hep arin during pregnancy. As a result, MIFD did not recur in all cases of the treated group and 87.5% (7/8) of the treated group could deliver approximate-for-date infants compared with 33.3% (2/6) of the untreate d group (p < 0.05). These results indicate that anticoagulant and anti platelet therapies are extremely effective for prevention of MIFD and IUGR due to MIFD.