False Umbilical Cord Knot

Kocher Clamp Rupture Membranes

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...

Massive Perivillous Fibrin Deposition

Marginal Infarction Placenta

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...

Monoamniotic Twins

Fetus Papyraceous

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...

Umbilical Cord No Twist

Umbilical Cord Accident

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...

Conjoined Twins Fetal Development

Conjoined Twins Always Monozygotic

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...

Velamentous Cord Insertion

Velamentous Insertion Placenta

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....

Placenta Amniotic

Plazenta Amnion Chorion

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...

Amnion Chorion Placenta

Fetal Membranes Amnion Chorion

, 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

Placenta Previa First Trimester

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

Gross Placenta Subchorionic Fibrin

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...