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The Placenta

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Abstract

It has been estimated that between 25 and 50 % of placentas of abnormal pregnancies have some useful morphologic information regarding the abnormality of pregnancy and that between 5 and 15 % of all placentas contain evidence of some abnormal intrauterine or genetic event. In the case of intrauterine fetal death, probable diagnoses of unsuspected infection, karyotype abnormality, and maternal systemic disease can be made in more than one-third of cases. Placental causes of death have been found in up to 64 % of intrauterine fetal deaths, depending on the classification system used to classify cause of death. Placental examination is therefore an essential component of the autopsy in cases of fetal or perinatal death.

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Author information

Authors and Affiliations

  1. Laboratory Medicine, Pediatrics and Obstetrics and Gynecology Tampa General Hospital Morsani College of Medicine, University of South Florida, Tampa, Florida, USA

    Enid Gilbert-Barness AO, MD, MBBS, FRCPA (Professor of Pathology and Cell Biology)

  2. Department of Pediatrics-Cardiology, University of Florida, Valrico, Florida, USA

    Diane E. Spicer BS, PA(ASCP)

  3. Department of Pathology, Tampa General Hospital, Tampa, Florida, USA

    Thora S. Steffensen MD

Authors
  1. Enid Gilbert-Barness AO, MD, MBBS, FRCPA
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  2. Diane E. Spicer BS, PA(ASCP)
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Appendices

Appendix 1: Placenta Gross Dictation

The specimen is received fresh, labeled with the patient’s name and medical record number. It consists of a ___  ×  ____  ×  ____ cm, _____ gram discoid, singleton placenta with attached membranes and umbilical cord.

The attached bi/tri/vascular cord is ___cm in length and ___ cm in diameter. It has central/eccentric/marginal/velamentous insertion, ___ cm from the edge (___ cm in the membranes). It is normally hypo/hyper coiled with ___coils per __ cm (or ___ coils per 10 cm), with/without/several/numerous false knots or true knots. Also received in the same container is/are __ detached portion/s of umbilical cord, ____ cm in length and ____ cm in diameter, with/without/several/numerous false knots or true knots and with ___coils per __ cm.

The fetal membranes are ____ (color), translucent/opaque, glistening/dull and have a marginal/___% marginal, ____% circummarginate, ____% circumvallate insertion with up to ___ cm rim of extrachorial placenta. The point of rupture is ___ cm from the edge/cannot be determined. They appear to be complete/not complete. The fetal surface is __________ (color) and glistening/semiopaque/dull/with a normal distribution of blood vessels. There is minimal/mild/moderate/marked subchorionic fibrin.

The maternal surface is ____ (color), ______ (consistency), and complete/disrupted. There is (no) retroplacental clot, located centrally/paracentrally/marginally/, measuring ___  ×  ___ cm, covering approximately ___ % of the maternal surface.

Cut surfaces are _____ (color), spongy/firm, with no/_____ (give number), central/paracentral/marginal, ________ (color)/firm/laminated/streak-like lesions ranging from ____ to ____ cm in greatest dimension. The lesions encompass approximately ____ % of the placental volume.

Representative sections are submitted as follows:

1A) Distal umbilical cord and membrane roll

1B) Proximal umbilical cord and normal central placenta

1C) Additional section of normal central placenta

If lesions, take additional sections including all lesions, and do not substitute normal sections with sections from lesions .

Appendix 2: Placental Weights for Normal Fetuses at Developmental Ages 8–18 Weeks

Fetal age (weeks)

Numbera

Placenta weight (g)

95 % confidence interval (g)

8

2

1.6

00

3.7

9

7

15.2

13.3

17.0

10

10

28.8

27.2

30.4

11

9

42.2

41.1

43.8

12

14

56.1

54.8

57.3

13

17

69.7

68.4

71.0

14

15

83.3

81.8

84.4

15

12

96.9

95.2

98.6

16

11

110.5

108.5

112.5

17

14

124.2

121.8

126.5

18

4

137.8

135.0

140.5

  1. aNumber of cases
  2. From: Kalousek DK, Fitch N, Paradice BA. Pathology of the human embryo and previable fetus: An atlas. New York: Springer; 1990. p. 228. With permission

Appendix 3: Percentiles, Means, and Standard Deviations for Placental Weights by Gestational Age

Gestational age (weeks)

Percentile

 

N a

Mean

SD

3

5

10

25

50

75

90

95

97

22

19

189

89

 

99

107

130

166

206

285

499

 

23

16

190

41

  

127

168

188

208

262

  

24

16

190

42

  

128

157

192

222

252

  

25

26

197

70

 

105

128

153

184

216

299

400

 

26

22

226

100

 

107

138

179

200

259

281

570

 

27

22

240

77

 

119

130

166

242

310

332

381

 

28

41

223

66

103

128

140

173

214

261

321

361

371

29

37

269

96

124

135

161

214

252

309

352

496

629

30

42

324

88

185

190

208

269

316

374

433

502

570

31

57

314

105

142

152

175

246

313

360

417

479

579

32

69

325

77

161

214

241

275

318

377

436

461

465

33

117

351

83

190

224

252

286

352

413

446

475

504

34

160

381

84

221

260

283

322

382

430

479

527

558

35

260

411

99

232

250

291

344

401

471

544

600

626

36

538

447

110

270

291

320

369

440

508

580

628

679

37

1,103

467

107

303

324

349

390

452

531

607

660

692

38

2,469

493

103

320

335

365

420

484

560

629

675

706

39

3,932

500

103

330

350

379

426

490

564

635

683

713

40

4,114

510

100

340

360

390

440

501

572

643

685

715

41

1,982

524

100

358

379

403

452

515

583

655

705

738

42

321

532

99

370

388

412

460

525

592

658

700

771

  1. SD standard deviation
  2. aNumber of placentas at each placental age
  3. From: Kraus FT, Redline RW, Gersell DJ, Nelson DM, Dicke JM. Placental pathology (Atlas of nontumor pathology), vol. 3. Washington, D.C.: AFIP; 2004. With permission

Appendix 4: Mean Weights and Percentiles for Twin Placentas

Gestational age (weeks)

90th Percentile

75th Percentile

Mean twin placental weight (g)

25th Percentile

10th Percentile

Number of cases

19

263

239

212

185

161

2

20

270

245

218

190

166

3

21

286

260

231

202

176

2

22

310

282

251

219

191

5

23

343

311

276

241

210

2

24

382

346

307

267

232

3

25

426

386

341

297

257

5

26

475

430

380

330

284

4

27

528

478

421

365

314

8

28

584

527

464

401

345

7

29

641

579

509

439

377

12

30

700

631

554

478

409

17

31

758

683

600

516

441

13

32

815

734

644

554

472

29

33

870

783

687

590

503

27

34

923

830

727

624

531

53

35

971

873

764

656

558

52

36

1,014

912

798

684

582

66

37

1,051

945

827

708

602

58

38

1,082

972

850

728

619

54

39

1,105

993

868

743

631

38

40

1,118

1,005

879

753

639

47

41

1,123

1,009

882

756

642

12

  1. Both dichorionic and monochorionic placental weights were included
  2. From: Pinar H, Sung CJ, Oyer CE, Singer DB. Reference values for singleton and twin placental weights. Pediatr Pathol Lab Med. 1996;16:904. With permission

Appendix 5: Mean Weights and Percentiles for Triplet Placentas

Gestational age (weeks)

90th Percentile

Mean triplet placental weight

10th Percentile

Cases (n)

20

285

253

226

3

21

320

284

257

2

22

345

319

289

2

23

400

361

331

3

24

445

406

371

5

25

498

456

408

6

26

558

509

444

6

27

630

564

480

4

28

697

621

516

5

29

772

679

553

6

30

849

738

591

10

31

925

797

631

15

32

1,000

855

674

7

33

1,072

911

719

14

34

1,139

965

768

43

35

1,200

1,017

821

33

36

1,253

1,065

878

19

37

1,297

1,108

940

8

38

1,330

1,147

1,007

5

  1. From: Pinar H, Stephens M, Singer D, et.al. Triplet placentas: reference values for weights. Pediatr Dev Pathol. 2002;5:495–98. With permission

Appendix 6: A Checklist for Umbilical Cords

Number of vessels

Length in cm

Insertion into the placental disk (and distance to margin)

Coiling (with maximum number of coils per 10 cm)

True knots

False knots

Areas of attenuation, thinning

Surface discoloration, plaques/lesions

Cyst or tumor

Amniotic band adhesion

Thrombus or hemorrhage

Appendix 7: Conditions Associated with Short Cords

Delay in second stage of labor

Abruption

Omphalocele

Inversion of uterus

Rupture

Decreased intrauterine movement

CNS dysfunction

Psychomotor impairments

Congenital neuromuscular disease

Appendix 8: Conditions Associated with Long Cords (>70 cm)

Prolapse of cord

True knots

Entanglement

High IQ

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Gilbert-Barness, E., Spicer, D.E., Steffensen, T.S. (2014). The Placenta. In: Handbook of Pediatric Autopsy Pathology. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-6711-3_4

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