B Buj
Figure 6.23. A Two of three fetuses were lost in this naturally occurring set of triplets. The surviving infant was female, while the two demises were male. Detailed examination of the dividing membranes showed them to be mono-chorionic and death was probably due to transfusion syndrome. These were biovular triplets, with split of one egg, the most common spontaneous type. B Maternal side of this placenta shows the extreme atrophy of the villous tissue belonging to the monochorionic twins right...
I 1
Figure 3.7. This mid-trimester fetal demise shows an excessively long and twisted cord. Markedly twisted cords may be associated with fetal compromise or death. Such twisting is not a postmortem artifact and is seen throughout gestation. No other cause of fetal death was found on complete autopsy with karyotype. associated with fetal morbidity and mortality Figure 3.7 . In general, one should be cautious in attributing fetal death to this or other cord problems particularly if congestion and or...
B Dei
Figure 6.23. A Two of three fetuses were lost in this naturally occurring set of triplets. The surviving infant was female, while the two demises were male. Detailed examination of the dividing membranes showed them to be mono-chorionic and death was probably due to transfusion syndrome. These were biovular triplets, with split of one egg, the most common spontaneous type. B Maternal side of this placenta shows the extreme atrophy of the villous tissue belonging to the monochorionic twins right...
B 1
Figure 5.18 Continued . B The three large clots received with the placenta fit the large and 2 other more subtle depressions. The involved areas of placental separation will extend well beyond the actual clot. Figure 5.19. Some retroplacental hemorrhages are not raised above the maternal surface and may not be appreciated until cross-sections are done. Trapping of maternal blood led to the large retroplacental clot which compressed the villous tissue. The villi above the blood are solid and...
Info Jzv
The general gross morphology of the placenta is established before the end of the first trimester, and further change is largely limited to growth and histologic maturation of villi. During placental examination the villous tissue is examined from the maternal side before and after transverse cuts have been made. While visual inspection is important, palpation of the placenta may be even more revealing of pathologic processes. Most villous lesions show diagnostic gross morphology. The common...
Monoamniotic Twins
Figure 6.13. Death of one twin at 19 weeks led to the formation of a fetus papyraceous in this term pregnancy. Morphology was adequately preserved to permit the histologic confirmation of the dividing membranes as monochorionic. While the etiology of the death of the infant is not fully determinable at this time, transfusion syndrome is likely. The surviving twin was at increased risk for vascular disruptive anomalies, but was uninvolved. The risk for disruption seems to become greater as the...
B Tod
Figure 6.7. B Dividing membranes of a monochorionic gestation only show two layers of amnion A . Figure 6.8. Vascular anastomoses in a monochorionic placenta are shown after removal of the amnions. The lower anastomosis shows large arteries a from each cord fusing in the center. The vessels, clear from injected water, are recognized as arteries because they pass over other vessels. Injection is usually not necessary to identify such large connections. Above this arrow is an area suggestive of a...
M
Figure 1.3. This placenta shows severe hemolytic coloration of the cord, membranes and surface. It was inadvertently placed in betadine scrub at delivery. A few bubbles are visible. Similar hemolysis will be seen if the placenta is frozen or left unrefrigerated. Figure 1.4. This term placenta was fixed in a nonformalin fixative for two days. There is no firming of the tissue as with formalin. Markedly meconium stained placentas will retain a green color, but other membrane changes are not...
Umbilical Cord No Twist
The umbilical cord is the lifeline of the fetus. Complete cord occlusion often leads to fetal demise while intermittent obstruction has been associated with intrauterine brain damage. Cord compression and vasospasm are important factors in fetal distress. Careful umbilical cord examination often reveals significant lesions which may be associated with these processes. The umbilical cord forms in the region of the body stalk where the embryo is attached to the chorion. This area contains the...
Info Qko
Today in the United States, at least one in 100 births is a multiple gestation and the examination of these placentas is one of the most important aspects of gross placental pathology. Twins account for a disproportionate percentage of perinatal morbidity and mortality and have significantly higher rates than singletons. Placentas of multiple gestations demonstrate all the abnormalities seen in singletons, as well as their own special pathology. While most of the following discussion relates to...
Info Ric
Figure 3.17. Both true cord hemorrhages and artifactual ones have a similar appearance on cross-section. The blood often tracks for considerable distances along the vessels. In problematic cases, multiple microscopic sections from the area may show vital changes. decreased fetal movement oligohydramnios, arthrogryposis . They are also associated with more problems in neurological development, suggesting the associated infants may have had longstanding in utero problems compromising mobility....
Info Wrf
Figure 5.33. Maternal floor infarction is a recurring lesion is associated with growth retardation and death. In this process there is a layer of fibrin deposited at the base for 3 mm to 4 mm. Basal villi are entrapped and die, but it is not true infarction. This occurs in combination with some degree of diffuse perivillous fibrin deposition, as shown here. This placenta is from a live-born infant. Figure 5.34. This more dramatic example of maternal floor infarction is from a 25 week stillborn....
Gritty Placenta
g. ' r .ry . . gt ft. f t v ' ' i t , . . ' Figure 5.2. Yellow-white areas of abundant calcification can be seen on the red maternal surface of this normal term placenta. It will also be present within the parenchyma, giving a gritty sensation and sound on cutting. Grossly visible calcification is quite variable, but tends to increase with advancing gestation. It is not associated with disease, even if large amounts are present. Figure 5.3. The parenchyma of this immature 24-week placenta shows...
Placenta Amniotic Sac
The peripheral membranes and fetal placental surface are continuous, and most processes are seen in both. The layer of membrane closest to the fetus is amnion. External is the chorion, which is minimal on the peripheral membranes and more extensive on the disk. The remnant of the yolk sac lies between the amnion and chorion Figure 4.1 . The chorion is continuous with all the villous tissue. There is close proximity of the surface membranes to the maternal blood of the intervillous space, while...
V
, Sf . ltt i-v. c . - A lt Figure 1.6. This view of the maternal surface in a term placenta shows the villous tissue to be complete, except for a small area of disruption at 5 o'clock. The placental cotyledons are vaguely outlined. A small amount of loose, soft, postpartum clot is present which should be removed prior to weighing and further examination. There are large and small yellow flecks of calcium. point of rupture at the center of the roll, which is held in place with a pin and cut from...
Gestational Sac Embryology
Basic Placental Anatomy and Development Some appreciation of placental development and structure is necessary to understand its examination and certain pathology. While the placenta shows extensive growth and histologic change in the second and third trimesters, the basic gross morphology is established early in pregnancy, before the end of the first trimester. Trophoblastic tissue is the major component of the placenta. By 4 to 5 days after fertilization, trophoblasts differentiate from the...
Subchorionic Fibrin Deposition
Detailed gross and light microscopic Pathology examination Pathology report to. mother's chart and infant's chart Refrigerate at 4 C for at least 3 days Figure 1.1. Scheme for placental triage. Adapted from Langston C, Kaplan C, Macpherson T, et al. Practice guidelines for examination of the placenta, Arch Pathol Lab Med 1997 121 449-476. Bouin's solution has often been used for placental fixation, and has the great advantage of hardening the membrane roll instantly. It does, however, lyse red...