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Pathol Annu. 1984;19 Pt 1:37-79.

Hemorrhagic endovasculitis of the placenta: an indepth morphologic appraisal with initial clinical and epidemiologic observations.


A vasodestructive process has been identified within the placenta, which focuses on the entire placental vascular tree. Its presence is correlated with significant fetal mortality; liveborn infants are growth retarded and frequently in distress. Characteristic morphologic features have been identified in chorionic vessels of all sizes and these explicit pathologic changes are repetitive from case to case. Associated events suggest that hemorrhagic endovasculitis of the placenta is a clinicopathologic entity having maximal impact on pregnancies of affected patients. A number of accompanying pathologic and clinical features would suggest an infectious association or cause. There are several known categories of disease which manifest similarity to this placental alteration. These include microangiopathic hemolytic anemia, several postinfectious states, several known types of vasculitis, and AIDS. Long-term studies to gain further insight into this pathologic event are currently underway at the Michigan Placental Tissue Registry. These studies include: an epidemiologic field investigation with followup on growth and development of liveborn infants; data collection and analysis with respect to recurrence, geographic distribution, and the clinical course of affected pregnancies. An indepth pathologic analysis is ongoing including ultrastructural and immunopathologic studies on affected and control placentas. Appropriate microbiologic and serologic studies are planned with reference to the infectious aspects of this entity we have described. It is hoped that increasing awareness of this pathologic process within the placenta, particularly by pathologists, will contribute to our understanding of events which are deleterious to intrauterine growth and survival.

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