Abstract

Background: Fetal vascular malperfusion refers to placental lesions indicating reduced or absent perfusion of the villous parenchyma by the fetus. Fetal vascular malperfusion remains an underrecognized condition that is associated with adverse perinatal outcomes. It may also predispose infants to thromboembolic events. There are few cases described of inferior vena cava and renal vein thrombosis in an asymptomatic newborn.
Case presentation: We report the case of an asymptomatic female neonate delivered at 32 weeks of gestation to a mother with type 1 diabetes and preeclampsia. Prenatal diagnosis of renal vein and inferior vena cava thrombosis was made at 30 weeks. Thrombophilia work-up was negative. Diagnosis was guided by the placental pathological examination that showed thrombosis of several fetal vessels of the chorionic plate, high-grade poor perfusion lesions and distal villous hypoplasia, suggestive of Fetal vascular malperfusion. Treatment with low-molecular-weight heparin was effective in the complete resolution of the thrombus and preservation of renal function.
Conclusion: This case emphasizes the importance of placental pathological examination in the presence of fetal abnormalities. Fetal vascular malperfusion may cause unrecognized neonatal thrombosis, which may result in growth impairment or organic dysfunction. Pregnant women with known risk factors for Fetal vascular malperfusion should be monitored more closely, both antenatally and postnatally, to detect possible placental and fetal target organ involvement at an early stage.

Key words: fetal vascular malperfusion; thrombosis; neonate; preterm; treatment; outcome