ABSTRACT
Background. Massive subchorionic thrombohematoma (MST), also known as Breus' mole, is a rare and poorly understood entity defined as a substantial collection of clotted blood in the intervillous space, immediately beneath the chorionic plate, measuring >1 cm in thickness with >50% involvement of the fetal surface of the placenta. The presumed pathophysiology is an aberrant collection of maternal blood, although this data is limited. MST has previously been associated with maternal thrombophilia and following thrombolytic therapy. Method(s): Four cases of MST diagnosed by pathological examination at our institution from 1/1/2021-7/1/2022 were identified using our laboratory information system. Maternal medical history, prenatal imaging, antenatal complications, gestation at delivery, and pregnancy outcome were extracted from the medical record. Result(s): We report a novel association of MST and maternal cardiac dysfunction, illustrated by four cases at a highrisk obstetric reference center covering a large portion of the southeastern United States. Two of these mothers had surgically repaired complex congenital heart disease, one had heart failure secondary to SARS-CoV-2 myocarditis, and one had longstanding high output heart failure due to severe sickle cell disease with resulting severe anemia. All of these pregnancies were complicated by intrauterine growth restriction (IUGR). Grossly, all four placentas had extensive fetal surface involvement by thrombohematoma (90-100%), but with variable degrees of placental volume replacement (range: 10-80%). Two of the four mothers had documented enoxaparin administration during pregnancy;however, there were no common medications given to all four mothers None had recognized thrombophilic disorders. Only one of four lesions was definitively identified on prenatal ultrasound. Of these four cases, three were live births, though only one infant survived past fifteen days of life. This surviving child had the least affected placenta grossly, was delivered at term, and was born to the only mother who did not require admission to the intensive care unit. Conclusion(s): We posit abnormal maternal hemodynamics are the final common pathway in the development of MST. Previous studies have shown blood within the thrombohematoma to be of maternal origin;furthermore, there is correlation within our case series between the largest lesions and the mothers with the most hemodynamic instability. IUGR is likely secondary to decreased placental reserve capacity from these space-occupying lesions. High fetal/neonatal morbidity and mortality rates underscore the need to further characterize this pathophysiologic process. That only one of four cases was detected on prenatal ultrasound illustrates the importance of both ante- and postnatal clinical and pathologic recognition.
ABSTRACT
In response to the global COVID-19 pandemic, many businesses closed their offices and asked their employees to work from home. The transition to remote work has yielded performance gains for many companies;so much so that many firms are planning to continue to use remote work after the pandemic subsides. Nevertheless, such benefits may not be distributed equally throughout the workforce. Drawing on the sociocognitive theory of socioeconomic status (SES), we predict that one's home working environment features salient signals of their social status that affect their performance. Based on a sample of 304 remote workers from within the United States collected during the COVID-19 shutdown, we find that individuals whose home offices connote higher levels of SES report a greater sense of control over their environment, which ultimately is associated with higher levels of perceived job performance. Furthermore, we find that the more time an individual spends in their home office, the stronger the relationship between their environment-based SES and their personal sense of control. Taken as a whole, our findings suggest that because home working environments are arrayed along an SES gradient, they present another mechanism by which pre-existing inequalities may be made salient as a result of the COVID-19 pandemic.