All things placenta

[LADoc00]

Interesting placentas are 88307s (I believe) and as such are supposed to be more complex than a 88305 lung bx you might sweat 30 minutes over...

What I want to know is:

1.) How many cassettes are people being trained to submit on placentas

2.) And what are people routining taking samples of

3.) How are people bottom lining negative placentas...

Im curious as I just was chatting about a locums I had who demanded to submit 5+ cassettes on a placenta, which everyone thought was crazy.

Ill start
1.) 1-2 cassettes, maybe 3 for a twin
2.) membrane, cord and bit of fetal and maternal side CV
3.) "unremarkable third trimester singleton placenta with 3-vessel cord"

 

[DarksideAllstar]

1. 2-3 cassettes (depends on singleton or twin and whether there is something really wrong with it).

2. Sections of membranes, distal and proximal cord, representative full cross section of central parenchyma (w/i 2 cm of cord insertion), representative full cross section of peripheral parenchyma (w/i 2 cm of the disc margin). Representative sections of any discrete lesions.

3. Dx line:
- (1st/2nd/3rd) trimester (singleton or twin) placenta.
- (two or three)- vessel cord.
- Unremarkable fetal membranes.

 

[yaah]

The teaching is to submit

Two sections of cord
Membrane roll including site of rupture (not sure if this is truly important or not)
Sections of disc including lesions

I usually used 3 cassettes, sometimes 4-5 depending on lesions. Occasionally two if the cord was small and the membrane roll was thin. A lot of the first years will submit 5 routinely. One block of cord, one block of membranes, and 3 of the disc.

The diagnostic line here is complicated because we have a (gasp) template including such things as presence of pigmented macrophages, inflammation, infarcts, hemorrhage, villitis, maternal decidual vasculature abnormalities, nucleated red blood cells, fetal:maternal weight ratio, etc. It often comes out like

A) Umbilical cord: Unremarkable 3 vessel cord
B) Membranes and maternal decidua: Meconium-laden macrophages present. Decidual necrosis, blah blah.
C) Disc: Mature third trimester placenta, appropriate for gestational age. Fetal to placental weight ratio 5.5 (with normal for gestational age in parentheses). Villous infarct blah blah.

Apparently there are lots of lawsuits over placentas, the attending who signs out most of them here talks about it a lot as he apparently sees them in consult. Kinda freaky.

 

[DarksideAllstar]

The teaching is to submit

Two sections of cord
Membrane roll including site of rupture (not sure if this is truly important or not)
Sections of disc including lesions

I usually used 3 cassettes, sometimes 4-5 depending on lesions. Occasionally two if the cord was small and the membrane roll was thin. A lot of the first years will submit 5 routinely. One block of cord, one block of membranes, and 3 of the disc.

The diagnostic line here is complicated because we have a (gasp) template including such things as presence of pigmented macrophages, inflammation, infarcts, hemorrhage, villitis, maternal decidual vasculature abnormalities, nucleated red blood cells, fetal:maternal weight ratio, etc. It often comes out like

A) Umbilical cord: Unremarkable 3 vessel cord
B) Membranes and maternal decidua: Meconium-laden macrophages present. Decidual necrosis, blah blah.
C) Disc: Mature third trimester placenta, appropriate for gestational age. Fetal to placental weight ratio 5.5 (with normal for gestational age in parentheses). Villous infarct blah blah.

Apparently there are lots of lawsuits over placentas, the attending who signs out most of them here talks about it a lot as he apparently sees them in consult. Kinda freaky.

Apparently UCSD has the King of Placental Pathology. I forget his name (and I'm too lazy to look it up), but I sat in on a few of his pediatric pathology conferences and they were pretty amazing. What was freaky though, is that the guy was so old school, that he was handling each placenta with his bare hands. I was like WTF? Apparently he also does placental path for the San Diego Zoo, so you can do some crazy autopsies/placental stuff there too, if you want.'

Edit:
His name is Benirschke.
Ok, so here is his book and here is some other website that I found.

 

[Gut Shot]

If UCSD has the King then we have the Empress. If we don't gross in the preferred manner we get beheaded. It's truly unreal what can be ascertained by a thorough examination. A standard gross will have five cassettes:

1: Maternal end of cord and membrane roll to include site of rupture
2: Fetal end of cord and membrane roll to include edge of placental disk
3: Non-marginal placenta adjacent to the cord insertion site
4-5: Non-marginal placenta (representative sections)

Typical diagnosis for normal cases looks something like this:

- Disk weight (vs. expected)
- Umbilical cord (three vessel, no vasculitis or funisitis)
- Membranes (no chorioamnionitis)
- Parenchyma (villi appropriate for X semester gestation, no vasculitis, viral cytopathic inclusions or infarction)

 

[mrp]

That'd be Dr. Benirschke at UCSD. Yes, he doesn't wear gloves, either for placentas or even autopsies. I was one of his placenta fellows last year. He is always on the residents case for wasting money on gloves. Totally old school, but he's awesome. He's 82 or 83, but still sharp as a tack.

We submit 4 cassettes--one membrane roll, one cord, one placental edge, one placental center. Sometimes three if we can get the roll and cord in one.

We bottom line a completely normal term placenta as...*drum roll*..."Mature Placenta". And that's it.

I did see some weird animal placentas from the SD Zoo. Lion placenta anyone? How about nutria? Alpaca? Lion placentas are pretty rare, as most lionesses eat them immediately after birth. Freaky.

 

[anencephalic]

Routinely 1 cassette each for membrane roll, disc margin/membrane insertion, cord insertion on maternal surface, and umbilical cord (total 4), plus 1-2 if any significant lesion/plaques/infarcts.

Signed out as:

1) _____ gm singleton placenta, mature, third trimester
2) membranes
3) umbilical cord
4) anything else

 

[yaah]

I did see some weird animal placentas from the SD Zoo. Lion placenta anyone? How about nutria? Alpaca? Lion placentas are pretty rare, as most lionesses eat them immediately after birth. Freaky.

Lions are scientologists?

How many placentas do most programs go through every day? Here we seem to average about 4 a day. A lot of placentas aren't submitted, as of now I think we depend on the clinicians to decide to send them to path, otherwise we'd get 15-20 a day which has happened when they changed their rules on how many to send. But what is nice here is that people on autopsy rotation deal with placentas, so once we are done with first year, no more placentas unless they get backed up and have to get distributed out.

 

[SLUsagar]

That'd be Dr. Benirschke at UCSD. Yes, he doesn't wear gloves, either for placentas or even autopsies. I was one of his placenta fellows last year. He is always on the residents case for wasting money on gloves. Totally old school, but he's awesome. He's 82 or 83, but still sharp as a tack.

We submit 4 cassettes--one membrane roll, one cord, one placental edge, one placental center. Sometimes three if we can get the roll and cord in one.

We bottom line a completely normal term placenta as...*drum roll*..."Mature Placenta". And that's it.

I did see some weird animal placentas from the SD Zoo. Lion placenta anyone? How about nutria? Alpaca? Lion placentas are pretty rare, as most lionesses eat them immediately after birth. Freaky.

dude, yes we tend to waste gloves, but that's just friggin' nass-tea. You're telling me he does autopsies bare handed and get **** and other goodies under his nails? I sometimes double gloves just when running the bowel...that smell can often stain through latex and linger for days.

 

[djmd]

dI sometimes double gloves just when running the bowel...that smell can often stain through latex.

Sometimes? Man, I live with two gloves on. Sometimes I take off one layer. sometimes.

Ok not live, but gross and autopsy always two gloves. Frozens thats a one glove.

 

[trent05]

Sometimes? Man, I live with two gloves on. Sometimes I take off one layer. sometimes.

Ok not live, but gross and autopsy always two gloves. Frozens thats a one glove.

Yeah. I always use 2 gloves for autopsies or anything unfixed. For grossing fixed specimens I'll use one. For frozens I use one to save time. No gloves is nuts!