Case History:

Placental membranes, 25 weeks gestation.

The pictured pathology is most likely associated with:

A. Ascending infection 

B. Preeclampsia 

C. Umbilical cord obstruction 

D. Viral TORCH infection 

Correct Answer: B. Preeclampsia

Discussion: 

In the center of the photograph are two maternal arteries in the decidual layer of the placental membranes. The vessel media have been replaced by thick, glassy, dark pink fibrin material (fibrinoid necrosis) with scattered embedded foamy macrophages (acute atherosis). This process is termed decidual arteriopathy and is due to a failure of the normal vascular remodeling during pregnancy. Decidual arteriopathy is most commonly seen in the setting of preeclampsia with fetal growth restriction and also may be seen in the setting of gestational and pregestational diabetes mellitus and connective tissue diseases. 

Case contributed by: Virginia Duncan, M.D., Perinatal Section Head, Associate Professor, Women's Health