Examination of Placenta and Umbilical Cord
Sample
- This is histopathological studies of the fetus on gross and microscopic examinations.
- This is basically an autopsy of the Foetus to find any abnormality.
Normal Placenta pathophysiology
- The placenta grows throughout the pregnancy. It is delivered through the birth canal immediately after birth.
- Placenta structure:
- Normally placenta measures about 22 cms and thickness are 2 to 2.5 cm.
- Usually, the placenta weight is around 470 G (500 to 600 Grams) and 15 to 20 cms in diameter.
- The maternal surface is dark brown and it is divided into lobules.
- It is a collection of fetal blood vessels called villi, which are surrounded by intervillous spaces in which maternal blood flows.
- The fetal surface is gray and shiny.
- The umbilical cord at birth is 55 to 60 cms in length and 2 to 2.5 cms in diameter.
- It has two arteries and one vein.
- Placenta functions:
- It keeps maternal and fetal circulation separate.
- It nourishes the fetus.
- It eliminates the fetal wastes.
- It produces hormones that are vital for maintaining pregnancy.
- Maternal immunoglobulins (IgG) cross the placenta by receptor-mediated endocytosis.
- Because of long life IgG, the newborn has protection for 6 months.
- The placenta is an effective barrier to large proteins and hydrophobic compounds bound to plasma proteins.
- Placental hormones are:
- Placental lactogen.
- Chorionic gonadotropin.
- Steroid hormones are:
- Progesterone.
- Estradiol.
- Estriol.
- Estrone.
Indication for the examination of the placenta:
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- In the case of premature birth.
- In intrauterine growth retardation.
- In the case of asphyxia.
- In the case of prenatal death.
- In the case of third trimester bleeding.
- In the case of fetal or maternal infection.
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Examination of the placenta:
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- Note the size, shape, color, and check for any smell.
- Check for the completeness of the placenta.
- Check for accessory lobes.
- Any placental infarcts.
- Any hemorrhage.
- Presence of tumors or nodules.
- Examine the umbilical cord for:
- It’s the length.
- Point of insertion.
- Check for the presence of any knot.
- If there is the absence of one artery, then there is the possibility of renal agenesis.
- Presence of any thrombosis.
- Evaluate the fetal membranes.
- Check for the presence of Wharton’s jelly.
- Send the placenta for histopathological examination.
- When there is prematurity.
- Intrauterine growth retardation.
- Asphyxia.
- Perinatal death.
- The third trimester bleeding and suspected fetal or maternal infection.
- If needed also do the culture.
- In some cases, ultrasonography may be advised.
- Note the size, shape, color, and check for any smell.
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Abnormality of the placenta:
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- Multi-lobes or bilobed placenta.
- Bipartite.
- Accessory lobes.
- Succenturiate.
- Placenta accreta.
- Placenta percreta.
- The Circumvallate placenta is on the fetal-placental side.
- Placental infarcts.
- Chorioangioma.
- Hydatidiform mole.
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Abnormality of the umbilical cord:
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- The cord may be short or long.
- The short cord is less than 40 cms in length.
- The long cord is more than 100 cms in length.
- Cord knot.
- An abnormal number of vessels.
- Thrombosis of the vessels.
- Different smell indicates infection.
- The cord may be short or long.
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Inflammation of the placenta:
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- Ascending infections are the most common. These are:
- Bacterial associated with premature birth.
- Premature rupture of the membrane.
- Infection beyond the membrane involves the umbilical cord.
- Through blood is a transplacental infection;
- Most commonly villi are involved.
- There are chances of TORCH in the fetus.
- Ascending infections are the most common. These are:
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Complications:
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- Any abnormality of the placenta or the umbilical cords may lead to:
- There may be perinatal morbidity.
- There will be abnormal fetal development.
- Any abnormality of the placenta or the umbilical cords may lead to:
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