Examination of Placenta and Umbilical Cord

Sample

1. This is histopathological studies of the fetus on gross and microscopic examinations.
2. This is basically an autopsy of the Foetus to find any abnormality.

Normal Placenta pathophysiology

1. The placenta grows throughout the pregnancy. It is delivered through the birth canal immediately after birth.
2. Placenta structure:
   1. Normally placenta measures about 22 cms and thickness are 2 to 2.5 cm.
   2. Usually, the placenta weight is around 470 G (500 to 600 Grams) and 15 to 20 cms in diameter.
   3. The maternal surface is dark brown and it is divided into lobules.
   4. It is a collection of fetal blood vessels called villi, which are surrounded by intervillous spaces in which maternal blood flows.
   5. The fetal surface is gray and shiny.
3. The umbilical cord at birth is 55 to 60 cms in length and 2 to 2.5 cms in diameter.
   1. It has two arteries and one vein.

4. Placenta functions:
   4. It keeps maternal and fetal circulation separate.
   5. It nourishes the fetus.
   6. It eliminates the fetal wastes.
   7. It produces hormones that are vital for maintaining pregnancy.
   8. Maternal immunoglobulins  (IgG) cross the placenta by receptor-mediated endocytosis.
      1. Because of long life IgG, the newborn has protection for 6 months.
   9. The placenta is an effective barrier to large proteins and hydrophobic compounds bound to plasma proteins.

5. Placental hormones are:
   1. Placental lactogen.
   2. Chorionic gonadotropin.
   3. Steroid hormones are:
      1. Progesterone.
      2. Estradiol.
      3. Estriol.
      4. Estrone.

Indication for the examination of the placenta:

1. 1. 1. In the case of premature birth.
      2. In intrauterine growth retardation.
      3. In the case of asphyxia.
      4. In the case of prenatal death.
      5. In the case of third trimester bleeding.
      6. In the case of fetal or maternal infection.

Examination of the placenta:

1. 1. 1. Note the size, shape, color, and check for any smell.
         1. Check for the completeness of the placenta.
         2. Check for accessory lobes.
         3. Any placental infarcts.
         4. Any hemorrhage.
         5. Presence of tumors or nodules.
      2. Examine the umbilical cord for:
         1. It’s the length.
         2. Point of insertion.
         3. Check for the presence of any knot.
         4. If there is the absence of one artery, then there is the possibility of renal agenesis.
         5. Presence of any thrombosis.
         6. Evaluate the fetal membranes.
         7. Check for the presence of Wharton’s jelly.
      3. Send the placenta for histopathological examination.
         1. When there is prematurity.
         2. Intrauterine growth retardation.
         3. Asphyxia.
         4. Perinatal death.
         5. The third trimester bleeding and suspected fetal or maternal infection.
      4. If needed also do the culture.
      5. In some cases, ultrasonography may be advised.

Abnormality of the placenta:

1. 1. 1. Multi-lobes or bilobed placenta.
      2. Bipartite.
      3. Accessory lobes.
      4. Succenturiate.
      5. Placenta accreta.
      6. Placenta percreta.
      7. The Circumvallate placenta is on the fetal-placental side.
      8. Placental infarcts.
      9. Chorioangioma.
      10. Hydatidiform mole.

Abnormality of the umbilical cord:

1. 1. 1. The cord may be short or long.
         1. The short cord is less than 40 cms in length.
         2. The long cord is more than 100 cms in length.
      2. Cord knot.
      3. An abnormal number of vessels.
      4. Thrombosis of the vessels.
      5. Different smell indicates infection.

Inflammation of the placenta:

1. 1. 1. Ascending infections are the most common. These are:
         1. Bacterial associated with premature birth.
         2. Premature rupture of the membrane.
         3. Infection beyond the membrane involves the umbilical cord.
      2. Through blood is a transplacental infection;
         1. Most commonly villi are involved.
         2. There are chances of TORCH in the fetus.

Complications:

1. 1. Any abnormality of the placenta or the umbilical cords may lead to:
      1. There may be perinatal morbidity.
      2. There will be abnormal fetal development.

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