Auto text: “Insert Placenta Twin” or “Insert Placenta Triplet”
Twin placentas can be fused or non-fused.
Membranes can be dichorionic/diamniotic, monochorionic/diamniotic, or monochorionic/monoamniotic. Di-Di and Mono-Di will have dividing membranes. Mono-Mono will not. There is no need to attempt to GROSSLY distinguish between Di-Di and Mono-Di. This can be done histologically.
The clinician should designate the first twin with one clamp on the cord and the second with two clamps, or state in the clinical history how to distinguish them. This should be incorporated into the gross description. If the clinician fails to do so, then you should state that the placentas are undesignated and then arbitrarily designate one placenta as A and one as B.
- Look at the vascular pattern on the fetal surface and at the dividing membrane to determine a rough approximation of the size and characteristics of each half.
- Check closely for a dividing membrane and take a membrane roll and if possible a “T” section.
- Treat each half as you would a singleton:
- 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 near placenta (1 cm from insertion), one near fetus.
- Measure (3D) and weigh placenta, after membranes and cord have been removed: If the discs are separate then weigh each. If they are fused then weigh the entire fused disc.
- Inspect maternal surface, noting any significant areas of disrupted cotyledons, fibrosis or infarct and estimate percentage of abnormality.
- Serially section the placenta, from the maternal surface through the fetal surface to look 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 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 if evident.
- 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 fixation purposes.