Breus' Mole: DNA Shows Massive Subchorionic Hematoma is Maternal in Origin

Abstract

Breus' mole, a massive subchorionic placental hematoma, is associated with intrauterine growth retardation and second trimester stillbirth. It is relatively rare and, hence, is poorly understood. Initially, Breus' mole was thought to be a consequence of fetal demise, but subsequent observations in placentas of live-born infants as well as identification in prenatal ultrasounds prior to fetal demise discredited this tenet. A number of theories have been proposed to explain the etiology of Breus' mole; some suggest that it is a fetal hemorrhage, others claim a maternal thombosis. However, these theories are based entirely on speculation, and it is unclear from the literature whether the source of the hematoma is maternal or fetal. A macerated female fetus was delivered of a 31-year-old G1 P0 woman at 24 weeks' gestation; the autopsy showed only marked intrauterine growth retardation while placental examination showed a massive subchorionic hematoma. DNAs extracted from portions of the fresh hematoma, placental villi (i.e., fetal tissue), and maternal blood were compared using molecular analyses. Polymerase chain reaction using primers that identify highly polymorphic loci distinguished fetal from maternal DNAs. This is the first case of Breus' mole analyzed using molecular methods; the source in this case is definitively maternal, suggesting the etiology is maternal thrombosis.

Key Words:

• Breus' mole
• DNA
• massive subchorionic hematoma
• placenta
• stillbirth