Maternal floor infarction is a rare placental lesion in which large amounts of fibrin are deposited along the basal plate, which becomes avascular and sclerotic. The rate of fetal salvage is very poor as the lesion develops rapidly.

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Available online at www.sciencedirect.com
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Case Report
Maternal floor infarction: A rare cause of sudden
intrauterine fetal demise
Astha Agarwal a,*, Shanti Jeyaseelan b
a Registrar, Indraprastha Apollo Hospitals, New Delhi, India
b Head of Department, Holy Family Hospital, New Delhi, India
a r t i c l e i n f o
Article history:
Received 14 March 2013
Accepted 22 June 2013
Available online 6 July 2013
Keywords:
Maternal
Infarction
Placenta
IUFD
Labor
a b s t r a c t
Introduction: Maternal floor infarction is a rare placental lesion in which large amounts of
fibrin are deposited along the basal plate, which becomes avascular and sclerotic. The rate
of fetal salvage is very poor as the lesion develops rapidly.
Case report: Booked G3P1L1A1 at 39 weeks gestation with obstetric history of an uneventful
FTNVD followed by a first trimester MTP. In this pregnancy she had a normal antenatal
course with reactive NST in last 2 visits at 37 and 38 weeks respectively. Routine NST 8 h
prior to admission was reactive. She had no complaints. Patient was admitted for elective
IOL. NST reactive at the time of admission. Routine FHR monitoring by Doppler after 2 h of
admission just prior to induction of labor showed absent FHR. Urgent USG done, confirmed
sudden IUFD. Patient and her family counseled. IOL done. She had normal vaginal delivery
of fresh stillborn male baby. Liquor was normal. Baby had no gross congenital anomaly.
Placenta had yellowish discoloration of a remarkably smooth maternal surface. Histopa-thology
was compatible with maternal floor infarction.
Conclusion: Placental dysfunction in maternal floor infarction appears late in the process of
the disease and the lesion develops rapidly within hours. Recurrence rate is as high as 39%
in subsequent pregnancies. In all cases of IUFD placenta should be sent for histopatho-logical
examination to rule out this rare cause of sudden IUFD at term.
Copyright ª 2013, Indraprastha Medical Corporation Ltd. All rights reserved.
1. Introduction
Maternal floor infarction is a rare placental lesion (incidence
0.09%e5%)1 in which large amounts of fibrin are found
deposited along the basal plate, which becomes avascular and
sclerotic. The findings are often associated with fetal demise
or premature delivery. The rate of fetal salvage is very poor
and the lesion may recur in subsequent pregnancies (inci-dence
39%).2
2. Case report
We report a case of booked 29 years old G3P1L1A1 who was
admitted for induction of labor at 39 weeks of gestation. Her
obstetric history was a full term normal vaginal delivery of a
healthy female baby at term 5 years back, followed by a first
trimester MTP for missed abortion.
In this pregnancy she had a normal antenatal course. All
the routine ultrasound were normal. Routine NST done for
* Corresponding author.
E-mail address: dr_astha_agarwal@yahoo.co.in (A. Agarwal).
0976-0016/$ e see front matter Copyright ª 2013, Indraprastha Medical Corporation Ltd. All rights reserved.
http://dx.doi.org/10.1016/j.apme.2013.06.001

3. 298 a p o l l o me d i c i n e 1 0 ( 2 0 1 3 ) 2 9 7 e2 9 8
fetal surveillance at 37 and 38 weeks were reactive with a
baseline fetal heart rate of 140 beats/min and variability of
8e10 beats/min. She was advised admission for IOL at 39
weeks. 8 h prior to admission NST done in OPD was also
reactive. Routine NST on admission was reactive. 2 h after
admission just prior to IOL routine fetal heart rate monitoring
was done with Doppler. The fetal heart sound could not be
localized and hence an urgent USG was done.
Urgent USG confirmed sudden intrauterine fetal demise.
Patient and her family were counseled. IOL done with cervi-prime
gel and the patient delivered fresh stillborn male baby
weighing 3.010 kg. Liquor was clear and not foul smelling.
Baby had no gross congenital anomaly. Placenta appeared to
be abnormal on gross examination. There was yellowish
discoloration of a remarkably smooth maternal surface.
Placenta was sent for histopathological examination. His-tology
was compatible with maternal floor infarction of the
placenta.
3. Conclusion
Maternal floor infarction is a rare placental lesion of unknown
etiology and is often associated with sudden intrauterine fetal
demise and intrauterine growth restriction. Placental
dysfunction appears late in the process of the disease and the
lesion develops rapidly within hours. In all cases of sudden
IUFD the obstetrician should sent the placenta for histopath-ological
examination to rule out this rare cause of sudden
IUFD.
4. Discussion
Maternal floor infarction of the placenta is a relatively rare
disorder that leads to sudden IUFD2 (incidence: 40%) and IUGR.
Thepathophysiologyofthe lesionremainsunclear.Maternal
floor infarction frequently recurs in successive pregnancies
(rate 39%)2 and there is evidence that it develops rapidly.3
It is a disorder, characterized by heavy deposition of fibrin
in the region of the basal villi immediately adjacent to the
decidua basalis. The fibrin extends into the intervillous space
where it envelops the basal villi, which becomes avascular
and sclerotic. It is not an infarct and is most directly distin-guished
from a placental infarct by the fact that, the affected
villi are widely separated by fibrin; whereas in infarcts the villi
are typically crowded together. Grossly, the maternal surface
of the placenta is thickened; firm and yellow.1 Given the risk of
recurrence to be as high as 39%, the identification of maternal
floor infarction (by either a history of sudden IUFD of un-known
etiology at term or a confirmed report of maternal floor
infarction in previous pregnancy) should alert the clinician to
the potential for growth retardation, preterm birth and sud-den
intrauterine fetal demise at term in subsequent preg-nancies.
Hence delivery should be considered when
pulmonary maturity has been established.2
Conflicts of interest
All authors have none to declare.
r e f e r e n c e s
1. Blaustein’s Pathology of the Female Genital Tract. 5th ed. 1135.
2. Andres Robert L, Kryper William, Resnik Robert. The
association of maternal floor infarction of the placenta with
adverse perinatal outcome. Am J Obstet Gynecol. July
1990;163:935e958.
3. Clewell William H, Manchester David K. Recurrent maternal
floor infarction e a preventive cause of fetal death. Am J Obstet
Gynecol. Sept 1983;1:346.

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