Subchorionic Fibrin Deposition

Detailed gross and light microscopic Pathology examination^

Pathology report to. mother's chart and infant's chart absent

Refrigerate at 4°C for at least 3 days

Maternal/Neonatal complications

Final speciment disposition

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.)

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 to using buffered formalin as their basic fixative. The question of whether to examine placentas fresh or fixed has long been debated without a definite answer as both methods are useful in various situations. The fresh placenta permits microbiological cultures, freezing of tissue for DNA samples, and the establishment of cell culture for karyotype or other testing. Frozen sections are easiest with fresh tissue. Injection studies in twins can only be done on fresh placentas. Surface changes are much better appreciated and membrane rolls are easily made. The fresh placenta is also more readily palpated for solid lesions. Unfixed pla-

Table 1.1. Indications fory placental examination

Fetal/neonatal

Stillbirth/perinatal death Hydrops

Multiple gestation Prematurity (<35 weeks) Postmaturity (>42 weeks) Intrauterine growth retardation Congenital anomalies (major) Possible infection Seizures

Admission to Neonatal Intensive Care Unit (NICU) Compromised condition at birth (e.g., low pH or Apgar scores)

Placental

Abnormal fetal/placental weight ratio

Extensive infarction

Single umbilical artery

Meconium staining

Suggestive of infection

Retroplacental hemorrhage

Excessive fibrin deposition

Villous atrophy

Chorangioma

Amnion nodosum

Maternal

Maternal disorders (e.g., hypertension, collagen disease, diabetes, drug abuse)

Possible infection/fever

Poor reproductive history

Abruptio placenta

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 less infectious, and may show infarcted regions better. Good fixation of an intact placenta will require several days' immersion in several times its volume of formalin. Except in cases of stillbirth, hemolytic coloration of the placenta usually indicates improper handling or storage (Figure 1.3).

Some facilities have largely eliminated formalin and use one of several recently developed nonformalin fixatives. These may be adequate for small biopsies but they do not penetrate very well. The placentas remain poorly fixed, even in adequate volumes. These fixatives also markedly change the gross appearance (Figure 1.4). On histology red cells are lysed and inflammatory cells poorly preserved. Postfixation in formalin will result in extensive pigment deposition.

Gross Placenta Subchorionic Fibrin

Figure 1.2. This intact fresh normal term placenta shows the fetal surface after refrigerated storage for two days.The surface is bluish with no opacity or unusual coloration. Subchorionic fibrin, usual in mature placentas, leads to the whiter areas. With longer storage or with large amounts of blood in the container, there is often more opacification grossly, without histologic findings. The cord is present inserting just off center. Free peripheral membranes can be seen at the margin.

Figure 1.2. This intact fresh normal term placenta shows the fetal surface after refrigerated storage for two days.The surface is bluish with no opacity or unusual coloration. Subchorionic fibrin, usual in mature placentas, leads to the whiter areas. With longer storage or with large amounts of blood in the container, there is often more opacification grossly, without histologic findings. The cord is present inserting just off center. Free peripheral membranes can be seen at the margin.

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Responses

  • leah
    WHAT IS SUBCHORIONIC FIBRIN?
    7 years ago
  • katie-leigh
    What is slight subchorionic fibrin deposition?
    6 years ago
  • edmund
    Is subchorinic fibrin deposition in plasanta normal or not?
    5 years ago
  • Lobelia
    What is fibrin deposit in placenta?
    4 years ago
  • JULIA
    What is subchorionic fibrin disposition?
    4 years ago
  • sandra baum
    Why is the fetal surface bluish?
    4 years ago
  • BLAINE WALLACE
    Are there fibrin deposits in post term placentas?
    2 years ago
  • grimalda
    What the solution of sub chorionic fibrin deposition?
    1 year ago
  • Tesfalem
    Is fibrin deposition in placental normal and healthy?
    7 months ago

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