Placental infarcts

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caryn
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Re: Placental infarcts

Postby caryn » Thu Jan 13, 2011 01:51 pm

I think of preeclampsia as the consequence of abnormal placentas. The fashion in which they are abnormal can vary dramatically from woman to woman, though. And "abnormal" is a technical term here -- it means "not in the middle of the bell curve." But placentas are also the most variable thing in our genomes by a long shot; they do things like spontaneously mutate (but just in one lobe. Or, you know, hey, two lobes. Or try being all one lobe!) because they don't have to work for very long and they have to operate in a very unique environment, at the interface of two different sets of genes without triggering immune responses. So the bell curve is weird and it is common to have an abnormal placenta!

Infarcts are quite common in all placentas, so what's relevant here is the history of preeclampsia rather than the specifics of placental pathology. As Angie says, there's preliminary data showing some benefit from the combination of Lovenox and baby aspirin, but no one's certain that this would pan out in a big randomized controlled trial. (Smaller studies can look promising and then not work in bigger more careful analyses.)
Science! The articles you don't want to miss:
The Preeclampsia Puzzle (New Yorker) and Silent Struggle: A New Theory of Pregnancy (New York Times)
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Caryn, @carynjrogers, who is not a doctor and who talks about science stuff *way* too much
DS Oscar born by emergent C-section at 34 weeks for fetal indicators, due to severe PE
DD Bridget born by C-section after water broke at 39 weeks after a healthy pregnancy

glimmer
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Re: Placental infarcts

Postby glimmer » Thu Jan 13, 2011 10:05 am

Interesting. I have no answers but an additional comment from my OBGYN. Whenever my protein came down, she said "well, that might not be a good sign, it might just be a consequence of the placenta "farcting off" (That was her term...)". However, my placenta was "normal" when I delivered at 38 weeks.
Actually it was unusually large and they thought that might have been an (atypical) consequence of the preeclampsia.

trish9
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Re: Placental infarcts

Postby trish9 » Thu Jan 13, 2011 08:34 am

It is confusing, considering how severe my condition was, I assumed that there would be more clear changes. I am going to discuss Lovenox with my OB and MFM and take a copy of the abstract that Kerisue posted.
Trish
Pre-eclampsia and HELLP at 23 weeks +2 days
My little love Alexander. Born and passed on January 3rd, 2010.
Underlying disorders: IgA nephropathy, chronic hypertension and Hashimoto's thyroiditis

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cmccaffrey
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Re: Placental infarcts

Postby cmccaffrey » Wed Jan 12, 2011 05:47 pm

trish9,
I have been wondering the same thing. I recently got ahold of the hospital records and I had less than 5% of infarcts, but the doctor told me I had full blown pre-eclampsia. I am meeting with her this week for a routine check up and I plan on asking her what she felt qualified me for pre-eclampsia besides the high blood pressure. All I can think about is what I might try differently next time around (definitely looking into lovenox). I also plan on getting tested for underlying problems, but it is just so frustrating not knowing how to make things work.
Christa (25) & J (26)
Mommy to:
Mason born 10.11.10 @ 30+3 wks due to Severe Pre-E. Only lived 2.5 days
Noah born 2.1.12 @ 38 weeks thanks to lots of doctors visits, LDA, Lovenox and no preeclampsia!

learn more about our story... http://tinyurl.com/7a979vy

angieb
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Re: Placental infarcts

Postby angieb » Wed Jan 12, 2011 10:59 am

I decided to do lovenox and there was nothing glaringly obvious in the placenta pathology report. (If I remember correctly, someone has said that all placentas have infracts so that's not really anything unusual.) Here's an interesting link to a study comparing women on lovenox/low molecular weight heparin and a control group without it, they did find that the women on lovenox/lmwh had better outcomes, although granted the study size was only about 80 women. http://www.ncbi.nlm.nih.gov/pubmed/21192252
Me (29) DH (30)
#1-Olivia Caetlyn-9-28-09-9-28-09, 23+2 wks, emergency classic c-section, class I HELLP, IUGR
#2- Lucas Oliver (rainbow baby)- April 2011, 36+2 wks, HELLP and pre-e free! (lovenox and LDA pregnancy)
#3-Matthew, late October 2012...mostly normal, 37 wks, (lovenox and LDA again)
My blog: http://www.butterflies-and-rainbows.blogspot.com/

trish9
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Placental infarcts

Postby trish9 » Wed Jan 12, 2011 10:48 am

Hi ladies,
After many letters and calls I was finally able to obtain my hospitalization records. On review of the placental path report it described "recent thrombi and infarct" The infarct was described as a single yellowish area and "less than 5% of the placental parenchyma". I thought that typically pre-e placentas had more infarcts? Anyways, I have not been identified with a clotting disorder, but wondered if given this information I should try to push for Lovenox in a subsequent pregnancy? Although my kidneys are better than we thought (creatinine clearance 86 yay!) I don't think that I will be permitted to take LDA given my history of kidney disease. Any thoughts or bits of info from the experienced?
Trish
Pre-eclampsia and HELLP at 23 weeks +2 days
My little love Alexander. Born and passed on January 3rd, 2010.
Underlying disorders: IgA nephropathy, chronic hypertension and Hashimoto's thyroiditis


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