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Fetal Vascular Malperfusion

Fetal Vascular Malperfusion is a condition that affects the blood flow in the developing fetus resulting in abnormal fetal development.

What are the other Names for this Condition? (Also known as/Synonyms)

  • Fetal Thrombotic Vasculopathy

What is Fetal Vascular Malperfusion? (Definition/Background Information)

  • Fetal Vascular Malperfusion is a condition that affects the blood flow in the developing fetus resulting in abnormal fetal development
  • Fetal Vascular Malperfusion can be caused by abnormalities, in any portion of the blood supply from the mother to the fetus, starting from the major umbilical vessels, chorionic blood vessels, and blood vessels in the terminal villi
  • The condition may be caused by a variety of maternal conditions, such as pre-eclampsia, diabetes, and factor V Leiden mutations, or umbilical cord abnormalities
  • The signs and symptoms of Fetal Vascular Malperfusion may include excessive hemorrhage during childbirth and decreased blood supply to the fetus, which may affect fetal growth and development
  • Fetal Vascular Malperfusion requires appropriate treatment (in some cases, an emergency C-section delivery) for an optimal outcome. The prognosis is dependent upon its severity and the underlying condition responsible for Fetal Vascular Malperfusion

Who gets Fetal Vascular Malperfusion? (Age and Sex Distribution)

  • Fetal Vascular Malperfusion may occur in pregnant women of all ages
  • Women who are pregnant with both male and female fetuses can be affected
  • There is no racial, ethnic, or geographical predilection observed

What are the Risk Factors for Fetal Vascular Malperfusion? (Predisposing Factors)

The risk factors for Fetal Vascular Malperfusion may include several conditions that affect the mother during pregnancy or the growing fetus. These may include:

  • Umbilical cord abnormalities related to the cord length, coiling, umbilical cord knots, etc.
  • Conditions involving the expectant mother including diabetes, pre-eclampsia, and protein S and protein C deficiency disorders
  • Certain infections affecting the mother and/or fetus

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Fetal Vascular Malperfusion? (Etiology)

The underlying causes of Fetal Vascular Malperfusion may include any of the following conditions:

  • Abnormal umbilical cord insertion
  • Abnormalities in umbilical cord length (under 35 cm or over 80 cm), such as short umbilical cord and long umbilical cord
  • Umbilical cord thrombosis
  • Abnormal coiling of the umbilical cord (when there is more than 3 coils per 10 cm)
  • True umbilical cord knots
  • Certain conditions of the mother such as:
    • Pre-eclampsia
    • Lupus anticoagulant
    • Diabetes
  • Any condition resulting in hypercoagulable state in mother including:
    • Factor V Leiden mutations
    • Protein S deficiency
    • Protein C deficiency
  • Heart malformation/dysfunction in fetus
  • Vascular abnormalities of the large blood vessels of the fetus
  • Polycythemia
  • Severe ascending intra-uterine infection
  • Cytomegalovirus (CMV) infection of fetus and placenta

What are the Signs and Symptoms of Fetal Vascular Malperfusion?

The signs and symptoms of Fetal Vascular Malperfusion may include:

  • Excessive hemorrhage/bleeding during childbirth 
  • Decreased blood flow to the fetus
  • Non-reassuring fetal heart rates

How is Fetal Vascular Malperfusion Diagnosed?

The diagnosis of Fetal Vascular Malperfusion may involve:

  • Physical examination along with an evaluation of one’s medical history
  • The healthcare provider may check for any signs of fetal distress (such as non-reassuring fetal heart rate)
  • Prenatal ultrasound scan of the developing fetus
  • Careful examination of the placenta with extensive tissue sampling of the blood vessels is important
  • In case of fetal death, autopsy of fetus with thorough examination of the placenta may be undertaken

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Fetal Vascular Malperfusion?

Complications due to Fetal Vascular Malperfusion may include:

  • Preterm birth
  • Intrauterine growth retardation (IUGR) and other congenital abnormalities in the developing fetus due to decreased blood flow to the growing fetus
  • Poor perinatal outcomes such as low Apgar scores
  • Neurodevelopmental disorders including (but not limited to) poor intellectual performance; cerebral palsy
  • Fetal abnormalities affecting a variety of organs such as poor limb development and intestinal atresia
  • The underlying condition in the mother resulting in Fetal Vascular Malperfusion may cause complications in the mother, either during or after the birth of the child
  • Excessive hemorrhage/bleeding during childbirth can result in increased fetal mortalities
  • Stillbirths and fetal demise

How is Fetal Vascular Malperfusion Treated?

  • There is no specific treatment available for Fetal Vascular Malperfusion
  • Treatment is directed towards managing the fetal complications associated with this condition. Delivery through an elective or emergency cesarean section may be necessary to avoid some of the complications, in some cases

How can Fetal Vascular Malperfusion be Prevented?

Currently, there are no definitive methods available to prevent Fetal Vascular Malperfusion, in many cases.

  • Good antenatal care can help in early recognition of the condition
  • Treating underlying conditions in mother that are responsible for Fetal Vascular Malperfusion may help decrease the risk

What is the Prognosis of Fetal Vascular Malperfusion? (Outcomes/Resolutions)

The prognosis of Fetal Vascular Malperfusion depends on the severity of the signs and symptoms and the underlying causative condition.

  • In some cases, the condition can have significant complications such as intellectual impairment and physical defects
  • Fetal Vascular Malperfusion is often an under-recognized condition with significant clinical implications
  • In some cases, if the underlying condition is severe, then the prognosis is poor

Additional and Relevant Useful Information for Fetal Vascular Malperfusion:

Please visit our Pregnancy-Related Disorders Health Center for more physician-approved health information:


What are some Useful Resources for Additional Information?

American Congress of Obstetricians and Gynecologists (ACOG)
409 12th Street SW, Washington, DC 20024-2188
Phone: (202) 638-5577
Toll-Free: (800) 673-8444
Website: http://www.acog.org

References and Information Sources used for the Article:

Baergen, R. N. (2011). Manual of pathology of the human placenta. Springer Science & Business Media.

Kraus, F. T., Redline, R., Gersell, D. J., Nelson, D. M., & Dicke, J. M. (2004). AFIP atlas of nontumor pathology: placental pathology. Washington, DC: American Registry of Pathology, 117-62.

https://www.ncbi.nlm.nih.gov/pubmed/29072954 (accessed on 01/14/2018)

https://www.semanticscholar.org/paper/Fetal-Vascular-Malperfusion-Heider/d4ac606916330114bfef6172871be53be1fdfade (accessed on 01/14/2018)

Helpful Peer-Reviewed Medical Articles:

Heider, A. (2017). Fetal Vascular Malperfusion. Archives of pathology & laboratory medicine, 141(11), 1484-1489.

Redline, R. W. (2015). Classification of placental lesions. American journal of obstetrics and gynecology, 213(4), S21-S28.

Apel-Sarid, L., Levy, A., Holcberg, G., & Sheiner, E. (2009). Placental pathologies associated with intra-uterine fetal growth restriction complicated with and without oligohydramnios. Archives of gynecology and obstetrics, 280(4), 549-552.

Kovo, M., Schreiber, L., & Bar, J. (2013). Placental vascular pathology as a mechanism of disease in pregnancy complications. Thrombosis Research, 131, S18-S21.

Burton, G. J., Yung, H. W., Cindrova-Davies, T., & Charnock-Jones, D. S. (2009). Placental endoplasmic reticulum stress and oxidative stress in the pathophysiology of unexplained intrauterine growth restriction and early onset preeclampsia. Placenta, 30, 43-48.

Khong, T. Y., Mooney, E. E., Ariel, I., Balmus, N. C., Boyd, T. K., Brundler, M. A., ... & Heazell, A. E. (2016). Sampling and definitions of placental lesions: Amsterdam placental workshop group consensus statement. Archives of pathology & laboratory medicine, 140(7), 698-713.

Mestan, K. K., Check, J., Minturn, L., Yallapragada, S., Farrow, K. N., Liu, X., ... & Ernst, L. M. (2014). Placental pathologic changes of maternal vascular underperfusion in bronchopulmonary dysplasia and pulmonary hypertension. Placenta, 35(8), 570-574.

Man, J., Hutchinson, J. C., Heazell, A. E., Ashworth, M., Jeffrey, I., & Sebire, N. J. (2016). Stillbirth and intrauterine fetal death: role of routine histopathological placental findings to determine cause of death. Ultrasound in Obstetrics & Gynecology, 48(5), 579-584.