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Pediatric and Fetal Autopsies
Published in Cristoforo Pomara, Vittorio Fineschi, Forensic and Clinical Forensic Autopsy, 2020
Stefano D’Errico, Angelo Montana, Giulio Di Mizio, Monica Salerno
Samples of placenta: The general characteristics of the internal structure of the placenta are approached by performing serial sections of the whole organ with a long flat knife along its major axis, at intervals of approximately 1.0–1.5 cm, extending from the fetal to the maternal surface; these sections should be from the central region, rather than from the margin, which is often nonrepresentative (Figure 3.81). One section must cross through the point of umbilical cord insertion. These samples of the villous parenchyma should be taken to include the full thickness of the placenta, including fetal and maternal surfaces. The sections of the villous tissue should be taken away from the margin of the placenta, as the perfusion is not consistent throughout the placenta and abnormalities exist in the peripheral areas of poor perfusion that may not be reflective of the remainder of the specimen. Sections of the fetal surface with chorionic vessels should be included in those sections of villous tissue.
Pathologic abnormalities of placental structure and function in diabetes
Published in Moshe Hod, Lois G. Jovanovic, Gian Carlo Di Renzo, Alberto de Leiva, Oded Langer, Textbook of Diabetes and Pregnancy, 2018
Rhonda Bentley-Lewis, Maria Rosaria Raspollini, Drucilla Roberts
The placental surface is red and spongy at term. A darkred color suggests congestion of capillaries or chorangiosis that may be associated with maternal diabetes (Figure 11.2). Placental thickness is usually between 1.5 and 3 cm but diabetic placentas are often thicker. Macroscopic analysis of the fetal surface of the chorionic plate should include evaluation of the chorionic vessels for evidence of thrombosis. Dilated and/or discolored vessels suggest fresh thrombosis, while tan–white or yellow fibrosed vessels are indicative of an old thrombus. Thrombosis of chorionic vessels is more common in maternal diabetes but can also be seen in vascular anomalies accompanied by local trauma or stasis, including true knots of the umbilical cord, velamentous cord insertion, and umbilical cord entanglement.31 Thrombosis can also be found in thrombophilic states, fetal chromosomal disorders, toxic agents to fetal vessels, and some viral infections.4
TRAP Sequence in Monochorionic/Monoamniotic (MC/MA) Discordant Twins: Two Cases Treated with Fetoscopic Laser Surgery
Published in Fetal and Pediatric Pathology, 2018
Gabriele Tonni, Gianpaolo Grisolia, Paolo Zampriolo, Federico Prefumo, Anna Fichera, Paola Bonasoni, Mathilde Lefebvre, Suonavy Khung-Savatovsky, Fabien Guimiot, Jonathan Rosenblatt, Edward Araujo Júnior
In the placenta, the TRAP sequence is characterized by superficial vascular connections that exclude the deep villous placental circulation to the acardiac twin. These vascular anastomoses are among chorionic vessels and consist of wide artery–artery (A–A) and vein–vein (V–V) connections. In this kind of vascular organization, the normally formed co-twin, known as the pump twin, directly perfuses the acardiac twin through the umbilical artery (A–A connection) with subsequent reversed circulation. In normal condition, oxygenated blood from the placenta perfuses the fetus through the umbilical vein and then goes via the ductus venosus to the right atrium. In TRAP sequence, the blood from the artery of the pump twin perfuses directly the acardiac twin at the level of the internal iliac arteries. It is a mixture of blood that comes from oxygenated blood from the aortic arch and the desaturated blood from the fetal venous system (from the ductus arteriosus). Except from the head and the upper limbs that recieve highly oxygenated blood thanks to the right-left shunt of the foramen ovale, this mixed blood is adequately oxygenated for the rest of the body of the normal twin [31–33]. However, the pump twin may also have complications from this abnormal circulation, especially high-output cardiac failure leading to fetal hydrops. Moreover, the pump twin receives decreased oxygenated blood due to mixing of the deoxygenated umbilical vein blood from the reversed circulation of the acardiac twin. In fact, the mortality rate for the pump twin is high as 50%, which also involves the consequences of therapeutic treatments [34].
Placental Pathology in Beckwith–Wiedemann Syndrome According to Genotype/Epigenotype Subgroups
Published in Fetal and Pediatric Pathology, 2018
Lucie Gaillot-Durand, Frederic Brioude, Claire Beneteau, Frédérique Le Breton, Jerome Massardier, Lucas Michon, Mojgan Devouassoux-Shisheboran, Fabienne Allias
Macroscopic features were collected from the initial pathological report: placental weight, presence of dilated chorionic vessels, cysts or vesicles, and chorangiomas. Hematoxylin-eosin-saffron (HES) stained slides were prepared from paraffin-embedded blocks. The number of HES slides examined for each case was collected. All placental slides were reviewed by two pathologists (FA and LGD) blinded to molecular diagnosis. Placentomegaly, PMD, chorangioma or chorangiomatosis, and extravillous trophoblastic cytomegaly were evaluated. We selected these three specific placental lesions for analysis according to our own experience and to the literature reporting pathological findings in BWS placenta [11, 12, 15–21].