Discordancy for maternal floor infarction in dizygotic twin placentas

Maternal floor infarction (also known as massive perivillous fibrin/fibrinoid deposition) is a rare and devastating pregnancy disorder associated with prematurity, fetal growth restriction, spontaneous abortion, and long-term neurologic impairment. Recurrence in multiple pregnancies is common. Little is known regarding either the pathophysiology or the management and treatment of patients at risk for recurrence in subsequent pregnancies. Most authors have emphasized maternal risk factors believed to act in a dominant fashion irrespective of fetal genotype. We report on dizygotic twins discordant for the development of placental maternal floor infarction and fetal growth restriction. The mother was a poorly controlled class C diabetic, and the onset of disease was coincident with the clinical onset of preeclampsia. This case demonstrates that fetal genotype, or some other factor specific to an individual fetoplacental unit, can lead to the differential expression of maternal floor infarction in dizygotic twins gestating in the same intrauterine environment.