blood clot in placenta?

[ellemoon]

I had my daughter last April at 29w1d due to severe pre-e. After the pathology came back on the placenta, my doctor informed me that there was 20% placental abruption. Looking at the report further, I noticed it said there was a blood clot on the maternal side of the placenta.
I'm quite confused...was the blood clot a defense mechanism against the abruption? (I never had any bleeding) or do I need to insist that I be on anticoagulation therapy during my next pregnancy? They've done a few tests for clotting disorders but those came back negative. There's still a lot they didn't test for and I'm going to push it. I also developed what they thought was a superficial blood clot in my left calf 2 days after my c-section. With all of these things combined, it makes me think that I should be on Lovenox during the next pregnancy-despite what the blood tests show.
Do any of you have experience with this placental abruptions/blood clots in your placenta? I know we are very lucky that things ended up being fine- I know the outcome could have been terrible.

Thanks so much in advance! I know you guys aren't doctors but I know a lot of you have researched the heck outta this disease and probably know more than some doctors do! I figured someone may have experienced the same thing and could give some insight.

[MomTimesThree]

I don't have any answers but I'll be watching your thread closely. We just got out pathology back and it also showed clots and an abruption- which we think happened right before delivery as she went into distress. I'll be curious what folks say.

So thankful she made it here safe, we also are in retrospect very fearful for what might have happened.

[angieb]

I had HELLP at 23 wks, with severe growth restriction, and my placenta had a lot of infracts (dead tissue) for the gestation I delivered at, not to mention my mom can't be on hormonal birth control without blood vessels bursting (though she's never been tested for a clotting disorder), and I bruise easily.

All of my underlying condition tests including a thrombophilia panel came back normal, but my MFM is of the opinion that I probably have some sort of clotting disorder that they don't have tests for/ don't know about yet. That being said, I saw another MFM who said everything looks normal with the testing and absolutely no to blood thinners. So you will find varying opinions on stuff like that, but you could most likely find an MFM somewhere (maybe even whoever you are already seeing) who might be willing to go that route. (I really felt like I was more comfortable being on them.)

I have been on blood thinners- low dose aspirin and lovenox- for both of my subsequent pregnancies. Last time, I stopped lovenox around 28 weeks because I wasn't having any issues and DS was clearly not going to be growth restricted. This time she let me stop around 26 weeks for the same reasons. If I had a known clotting disorder, she probably wouldn't have let me stop, but I've continued with low dose aspirin both pregnancies until shortly before delivery...only 28 weeks this time, but so far, so good.

[caryn]

The clot's probably just what normally happens when a blood vessel breaks - it clots off.

Most placentas have some areas of infarct - as Angie says, this is more worrisome if you have an unusual rate of infarcts for gestational age - and it's also common for there to be some areas of subchorionic hematoma. Small abruptions are common with preeclampsia.

It doesn't necessarily mean that you've got a clotting disorder, even an unknown clotting disorder. What's going on in preeclampsia is a conflict between the maternal and paternal genes expressed in the placenta over size of the fetus at delivery; if the argument between them can't be negotiated to an agreement, placentas start to fail. One possible maternal strategy to cut down on fetal growth rate is to detach some, but not all, of the placenta, so that it can supply fewer nutrients to the fetus, so the fetus grows more slowly and is more likely to fit out.

The underlying conditions that go along with preeclampsia are almost always conditions that mean you've got a hyperactive innate immune system, which means hypertension, diabetes, autoimmune conditions, and other conditions associated with baseline inflammation levels. The general problem seems to be that we've got a glass half full of inflammation already, and at some point in pregnancy, the cup runneth over.

Hope this helps! I'm finding myself prone to use too much jargon this week so holler if none of this makes sense.

[ellemoon]

Thanks guys!
There were a lot of infarcts (sp?) as well as a significant amount of "Syncytial knots" in the placenta. Does anyone have any insight on those? All of thise is so confusing! I want to make sure nothing is missed. I would feel MUCH better if my doctor would agree to Lovenox, simple because my medical history is kind of sketchy. I also have chronich HTN and have since I was 17. So, that makes me higher risk anyway.

[MomTimesThree]

Thank you Caryn! You are such a wealth of information, and thank you again Ellemoon for starting this thread.

Caryn, and/or other mommas, do you know what is coincided elevated infarcts (we had those too) and do they measure an abruption in percentage? I know we had one, and it says the size- but I'm at a loss to the context.. what is considered, small.. medium?

Thanks! -Lauren

[caryn]

IIRC, infarcts are measured relative to gestational age and size. So if 4% of the placenta was infarcted, but it is normal at the gestational age you're at to have only 2% infarcted, you have elevated levels of infarction. And abruptions are also measured relative to size of the disc.

I think they do the math for abruptions like this - if it's got radius 20cm it's got an area of pi r squared (or in this example 1256 sq. cm.) and the abrupted area has radius 6 cm so about 113 sq. cm. So you can just divide to figure out what percentage of the placenta abrupted: 113/1256 = .09, or 9% of the area of the placenta had detached from the uterus.

Really I should get my act together and make a graphic for this - it would make much more sense! Hope that helps some...