color atlas of gross placental pathology 2nd ed - c. kaplan (springer, 2007)

[...]... incomplete The color, opacity, and other lesions such as hemorrhages and compressed twins are noted 6 A strip of membranes is cut from the edge of the site of rupture to the margin of the disk preferably from a thicker portion of the membranes with more attached decidua A “jellyroll” is made by grasping the end with long thin forceps and rolling toward the placenta This puts the Technique of Gross Examination... 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.) Fixation 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 cells and requires care in histologic processing Most labs have moved... Repetitive bleeding Oligohydramnios Polyhydramnios 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 centas may be held for several days refrigerated prior to gross examination Gross and microscopic changes are minimal, if any, over this time (Figure 1.2) The fixed placenta is more simply transported and stored, is... presence, length and intactness of any velamentous vessels Extra pieces of cord in the container should be noted and measured 4 The cord is inspected for true knots, twisting, and discolorations It is then cut several centimeters from its placental insertion and the cut end examined for the number of vessels and other abnormalities Maximal and minimal diameters are measured Portions of the cord from the proximal... Results to mother’s medical records Clinical indication for exam present absent Sampling of unfixed tissue, if needed, for: Microbial cultures cytogenetics Electron Microscopy Metabolic studies DNA Ploidy Studies Vascular perfusio studies, if needed Refrigerate at 4°C for at least 3 days Maternal/Neonatal complications yes no Detailed gross and light microscopic Pathology examination Pathology report to... 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,... sample The pieces of placental villous tissue should be from separate areas (different cotyledons), and not from the margin of the placenta, which frequently shows changes of diminished blood flow (Figure 1.10) The fetal surface of the section should include small blood vessels, and be free of substantial subchorionic clot or fibrin Early changes of ascending infection are often masked in areas with thick... recognized on light microscopy (Figures 2.3A,B) Placental Shape The shape of the placenta is quite variable Generally it is round to ovoid and about 18-cm to 20-cm diameter by 1.5-cm to 2.5-cm thick at term Failure of atrophy of capsular villi leads to succenturiate lobes (Figure 2.4, Figure 2.5) Bilobate placentas result from uterine sulcal implantation (Figure 2.6), while unusually shaped often multilobate... make the gross diagnosis of symptomatic accreta and its more invasive forms in a delivered placenta, and only rarely on placental microscopy Accreta may be found both grossly and microscopically in post-partum currettings for bleeding (Figure 2.14) Partial myomectomies of regions with increta are occasionally performed (Figure 2.15) Abnormal adherence of the placenta is not the only cause of life threatening... measurement and will vary with the methodology of examination It is affected by fixation, the presence of cord, membranes, and loose clot, the amount of blood retained, and the intactness of the maternal surface Fresh refrigerated placentas lose a small amount of weight with storage, whereas formalin fixation leads to an increase, no more than 10% in either case The value of placental weight is largely at the extremes, .