Table of Contents

PART 1: OVERVIEW GROSS AND MICROSCOPIC CHANGES SECTION I: UMBILICAL CORD Gross Evaluation and Normal Histology of Umbilical Cord Knots Umbilical Cord Edema and Thinning Histopathologic Changes of Umbilical Cord SECTION II: EXTRAPLACENTAL MEMBRANES Gross Evaluation and Normal Histology of Membranes Histopathologic Changes of Membranes SECTION III: CHORIONIC PLATE Gross Appearance and Normal Histology of Chorionic Plate Histopathologic Changes of Chorionic Plate SECTION IV: STEM VILLI Gross Appearance and Normal Histology of Stem Villi Histopathologic Changes of Stem Villi SECTION V: CHORIONIC VILLI Gross Appearance and Normal Histology of Chorionic Villi Histopathologic Changes of Chorionic Villi SECTION VI: DECIDUA Gross Appearance and Normal Histology of Decidua Histopathologic Changes of Decidua PART 2: DIAGNOSES Hydropic Degeneration and Hydatidiform Mole Choriocarcinoma Placental Site Nodule and Exaggerated Placental Site Placental Site Trophoblastic Tumor and Epithelioid Trophoblastic Tumor SECTION I: MECONIUM Meconium-Stained Placenta SECTION II: AMNIOTIC FLUID INFECTION SEQUENCE Amniotic Fluid Infection Sequence (Maternal and Fetal Inflammatory Response) Group B Streptococcus Other Bacterial and Mycobacterial Species Candida Infection SECTION III: VILLITIS ASSOCIATED WITH SPECIFIC INFECTIONS Cytomegalovirus Parvovirus B19 Herpes Simplex Virus Other Viruses Syphilis Coccidioidomycosis Parasitic Infections SECTION IV: CHRONIC VILLITIS OF UNKNOWN ETIOLOGY Cellular Composition of Chronic Inflammatory Lesions Chronic Villitis and Intervillositis Basal Chronic Villitis and Chronic Deciduitis Chronic Chorioamnionitis Eosinophilic/T-Cell Chorionic Vasculitis SECTION V: MASSIVE PERIVILLOUS FIBRIN DEPOSITION AND MATERNAL FLOOR INFARCTION Massive Perivillous Fibrin Deposition and Maternal Floor Infarction SECTION VI: FETAL VASCULOPATHY Large Vessel Fetal Vascular Occlusion Distal Villous Lesions of Fetal Vascular Occlusion SECTION VII: PLACENTAL ABRUPTION Acute Abruption and Retroplacental Hematoma Chronic Abruption SECTION VIII: VILLOUS HYPERVASCULAR LESIONS Chorangiosis Chorangiomatosis Chorangioma SECTION IX: METASTES TO THE PLACENTA Metastatic Tumors SECTION X: PLACENTAL MESENCHYMAL DYSPLASIA Placental Mesenchymal Dysplasia PART 3: PLACENTAL EVALUATION IN SPECIAL CIRCUMSTANCES SECTION I: CHANGES CONSISTENT WITH GESTATIONAL DIABETES Gestational Diabetes Placentomegaly Distal Villous Immaturity SECTION II: PREECLAMPSIA AND OTHER DISORDERS Preeclampsia and Related Hypertensive Disorders Small for Gestational Age Placenta Distal Villous Hypoplasia Maternal Decidual Vasculopathy Infarcts Extravillous Cytotrophoblast Cysts Laminar Necrosis of Decidua SECTION III: FETAL-MATERNAL HEMORRHAGE Fetal-Maternal Hemorrhage SECTION IV: PLACENTAL EVALUATION FOR SMALL FOR GESTATIONAL AGE INFANT Placental Causes of Poor Fetal Growth SECTION V: PLACENTAL EVALUATION IN PREMATURITY Premature Birth SECTION VI: PLACENTAL EVALUATION IN ABNORMAL PLACENTAL IMPLANTATION Placenta Accreta SECTION VII: PLACENTAL EVALUATION IN INTRAUTERINE FETAL DEMISE 1st Trimester 2nd Trimester 3rd Trimester Recurrent Pregnancy Loss In Utero Demise to Delivery Interval Changes SECTION VIII: PLACENTAL EVALUATION IN MULTIPLE GESTATIONS Complications of Monochorionic Monoamnionic Gestations Twin Growth Discrepancy Twin-Twin Transfusion Syndrome After In Utero Intervention for Twin-Twin Transfusion Syndrome Triplet and Higher Order Placenta SECTION IX: THE POSTPARTUM HYSTERECTOMY Evaluation of Postpartum Hysterectomy Postpartum Hemorrhage PART 4: APPENDIX SECTION I: REFERENCE CHARTS FOR PLACENTAL EVALUATION Reference Value Weights for Singleton Placentas Reference Value Weights for Twin Placentas Reference Value Weights for Triplet Placentas Reference Values for Fetal and Placental Growth in Early Pregnancy SECTION II: SAMPLE TEMPLATES FOR PLACENTAL EVALUATION Singleton Placenta Gross Evaluation Template Twin Placenta Gross Evaluation Template Placenta Microscopic Evaluation Template Placenta Triage Template

About the Author

Amy Heerema-McKenney, MD is Director of Perinatal Pathology at the Robert J. Tomsich Pathology and Laboratory Medicine Institute, Division of Anatomic Pathology for Cleveland Clinic in Cleveland, Ohio Monique De Paepe, MD, MSc is Professor of Pathology and Laboratory Medicine at Women and Infants Hospital, Alpert Medical School of Brown University in Providence, Rhode Island Edwina J. Popek, DO, is

Professor Emeritus of Pathology, Immunology and Pediatrics, Baylor College of Medicine, Texas Children's Hospital Pavilion for Women in Houston, Texas