Auto text: “Insert Placenta Single”
Notes
Placental shapes:
- Discoid: oval or triangular disc
- Duplex: bilobed, separated by membrane
- Bipartite or Tripartite: bidiscoidal or tridiscoidal with incomplete separation
- Succenturiate: has smaller accessory lobe
Membrane insertions:
- Marginal: Normal insertion of membranes at the placental edge.
- Circummarginate: Membranes insert inside the edge (ring of membrane is flat and, unlike normal membrane, does NOT extend to the very edge of the disc)
- Circumvallate: Membranes insert inside the edge AND fold back onto themselves (a double layer of amnion, chorion, necrotic villi and fibrin form a raised white ring around the surface of the disc)
Gross
- Examine fetal membranes for color, consistency, translucency.
- Trim a strip from the rupture site to the placental margin, and create membrane roll. Submit one section of membrane roll. Remove remainder of membranes from placental disc.
- Measure cord length, diameter, distance from margin of placental disc.
- Remove cord, lay flat, and examine for number of coils (1-2 every 5 cm is normal; more than 2 per 5 cm is abnormal).
- Examine cord for number of vessels. Submit two sections of cord: one 1 cm from cord insertion site, one near fetus.
- Measure (3D) and weigh placenta, after membranes and cord have been removed.
- Inspect maternal surface, noting any significant areas of disrupted cotyledons, fibrosis or infarct. Estimate the percentage of disrupted maternal surface.
- Serially section the placenta, starting from the maternal surface through to the fetal surface looking for infarcts, hemangiomas or other lesions.
- If infarcts or other discrete lesions are noted, they should be characterized, i.e. number, size, location and approximate volume (by percent) of placental tissue involved.
- Clinically, if abruption or placenta previa, inspect the placenta for adherent blood clots and marginal hematomas, and check the bucket for large detached hematomas. Weigh and measure volume of clots.
- Submit one cassette of central placenta, one cassette of peri-central placenta (NOT the extreme periphery), and one cassette of multiple thin maternal sections (all from central aspect of disc). Central and peri-central sections should be full thickness including the chorionic plate, making sure to include fetal vessels.
- Submit on the FATS processor for appropriate fixation.
