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Obstetrical practice has always emphasized that gross examination of the placenta is integral following delivery. In some cases, findings prompt further action by the obstetrician or pediatrician. In addition, great strides have been made concerning the histopathological examination of placental tissue to provide clinically useful information. Pioneering efforts in this field include those of Benirschke, Driscoll, Fox, Naeye, Salafia, and Faye-Petersen.

Histopathological Examination

We agree with most authorities that routine placental examination by a pathologist is not indicated, although there is still debate as to which placentas should be submitted. For example, the College of American Pathologists recommends routine examination for an extensive list of indications (Langston, 1997). However, data may be insufficient to support all of these. Certainly, the placenta and cord should be examined in the delivery room. As some correlation of specific placental findings with both short- and long-term neonatal outcomes is possible, the decision to request pathological examination should be based on clinical and placental findings (Redline, 2008; Roberts, 2008). Shown in Table 6-1 are indications used at Parkland Hospital to submit a placenta to the Pathology Department.

TABLE 6-1Some Indications for Placental Pathological Examinationa

Normal Placenta

Placental abnormalities are better understood with knowledge of placental implantation, development, and anatomy presented in Chapter 5 (Decidual Prolactin). At term, the “typical” placenta weighs 470 g, is round to oval with a 22-cm diameter, and has a central thickness of 2.5 cm (Benirschke, 2012). It is composed of a placental disc, extraplacental membranes, and three-vessel umbilical cord. The maternal surface is the basal plate, which is divided by clefts into portions—termed cotyledons. These clefts mark the site of internal septa, which extend into the intervillous space. The fetal surface is the chorionic plate, into which the umbilical cord inserts, typically in the center. Large fetal vessels that originate from the cord vessels then spread and branch across the chorionic plate before ...

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