Full placenta with cord Biopsy

Biopsy

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Placental histology.

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Full Placenta with Cord Biopsy - Comprehensive Medical Test Guide

Section 1: Why is it done?
- Test Description: A comprehensive histopathological and microbiological examination of the placenta, umbilical cord, and associated tissues obtained after delivery to identify abnormalities, infections, or pathological changes that may have affected fetal development or maternal-fetal health.
- Primary Indications: Recurrent pregnancy loss; intrauterine growth restriction (IUGR); unexplained fetal demise or stillbirth; maternal infection during pregnancy (rubella, CMV, toxoplasmosis, etc.); abnormal fetal development; preeclampsia or placental insufficiency; oligohydramnios or polyhydramnios; meconium-stained amniotic fluid; prematurity; neonatal complications; suspected placental abnormalities or tumors; maternal diabetes complications; thrombophilia-related complications; evaluation of placental size or weight discrepancies
- Typical Timing: Performed immediately after delivery (vaginal or cesarean section); tissue collection within 30 minutes of placental expulsion; preservation methods depend on specific testing required (formalin for histology, sterile containers for microbiology, specialized media for culture)
Section 2: Normal Range
- Normal Placental Parameters: Weight: 400-600 grams (normal range varies with gestational age); Dimensions: 15-20 cm diameter, 2-3 cm thickness; Color: Dark red to reddish-brown; Consistency: Firm and spongy
- Normal Umbilical Cord Parameters: Length: 40-60 cm; Diameter: 1-2 cm; Three vessels present (two arteries, one vein); No knots, strictures, or abnormal attachments; Color: Pale bluish-white when fresh
- Normal Histological Findings: Mature chorionic villi with appropriate syncytiotrophoblast; Normal villous architecture without excessive syncytial knots; Minimal fibrin deposition; Normal intervillous space perfusion; Absent or minimal inflammation; No evidence of infection; Normal amnion and chorion layers; Appropriate maturation stage for gestational age
- Microbiology Results: Negative cultures (no bacterial, fungal, or viral growth); Negative for pathogenic organisms; Negative PCR for infectious agents when performed
- Interpretation of Normal Results: Indicates normal placental development and function; No evidence of infection; No significant pathological changes; Reassuring for fetal and neonatal outcome; Supports normal pregnancy progression
Section 3: Interpretation
- Abnormal Morphological Findings: Low placental weight (<400g): Suggests intrauterine growth restriction, maternal hypertension, or placental insufficiency; High placental weight (>600g): Associated with maternal diabetes, maternal anemia, fetal hemolytic disease, or congenital infections; Pale appearance: Indicates anemia or chronic hypoxia; Infarction areas: Suggest placental ischemia or thrombosis; Retained products: May explain delayed placental separation
- Abnormal Cord Findings: Single umbilical artery (SUA): Associated with chromosomal abnormalities, congenital heart disease, and IUGR; Short cord (<40cm): Increased risk of placental abruption, fetal distress, stillbirth; Long cord (>60cm): Increased risk of cord prolapse, cord compression, or entanglement; Thin cord: Associated with placental insufficiency; Meconium staining: Indicates fetal distress; Abnormal insertion (velamentous): Associated with IUGR and abnormal fetal heart patterns; True cord knots: May lead to fetal compromise
- Inflammatory Findings: Chorioamnionitis: Maternal or fetal inflammatory response; Funisitis (cord inflammation): Indicates intrauterine infection; Acute chorioamnionitis: Suggests recent maternal or ascending infection; Chronic chorioamnionitis: Suggests prolonged intrauterine infection; Villitis: Fetal inflammatory response, often from intrauterine infection
- Infectious Findings: Positive bacterial cultures: Confirms intrauterine infection, may guide neonatal antibiotic therapy; Viral serology or PCR positive: Identifies specific intrauterine viral infection (CMV, herpes simplex, rubella, varicella, parvovirus B19); Fungal findings: Rare, often from maternal candidiasis or systemic fungal infection; Parasitic organisms: May indicate maternal parasitic infection
- Vascular and Ischemic Findings: Infarction: Areas of tissue death, suggests placental insufficiency or thrombosis; Accelerated maturation: Indicates placental aging, associated with preeclampsia or IUGR; Hypoplasia: Underdevelopment of villi, suggests inadequate placental development; Increased fibrin: Suggests maternal-fetal mismatch or thrombosis; Abnormal vasculature: May indicate congenital infections or genetic abnormalities
- Genetic/Congenital Findings: Molar changes: Suggest gestational trophoblastic disease; Hydropic changes: Indicate severe fetal compromise or hydrops fetalis; Teratomas or tumors: Rare placental neoplasms; Cystic structures: May represent developmental anomalies; Abnormal lobulation: Can indicate chromosomal abnormalities
- Factors Affecting Results: Gestational age at delivery; Maternal health conditions (diabetes, hypertension, preeclampsia); Fetal genetic abnormalities; Timing of specimen collection; Specimen preservation method; Environmental contamination during collection; Maternal infections during pregnancy; Labor complications; Delivery method (vaginal vs. cesarean); Maternal medications; Placental abruption or separation trauma
Section 4: Associated Organs
- Primary Organ Systems Involved: Placental endothelium (maternal and fetal circulations); Fetal vascular system; Maternal circulatory system; Immune system (both maternal and fetal); Fetal organs (heart, lungs, kidneys, brain - as affected by placental dysfunction); Neonatal systems (respiratory, cardiovascular, neurological)
- Diseases and Conditions Commonly Associated with Abnormal Results: Preeclampsia and eclampsia; HELLP syndrome (Hemolysis, Elevated Liver enzymes, Low Platelet count); Intrauterine growth restriction (IUGR); Placental abruption; Placenta previa; Gestational diabetes; Maternal hypertension (chronic and gestational); Antiphospholipid syndrome; Thrombophilias (Factor V Leiden, Prothrombin G20210A mutation); Recurrent pregnancy loss; Intrauterine fetal demise (IUFD); Preterm labor and delivery; Premature rupture of membranes (PROM); Chorioamnionitis and intrauterine infection; Congenital infections (TORCH, others); Maternal infections (bacterial vaginosis, urinary tract infections); Fetal anomalies and chromosomal abnormalities; Maternal diabetes mellitus complications; Hemolytic disease of the newborn; Hydrops fetalis; Fetal-maternal hemorrhage; Cord accidents and entanglement complications
- Potential Complications Associated with Abnormal Results: Neonatal sepsis or infection; Birth asphyxia and hypoxic-ischemic encephalopathy (HIE); Respiratory distress syndrome; Meconium aspiration syndrome; Intraventricular hemorrhage (IVH); Retinopathy of prematurity; Bronchopulmonary dysplasia; Necrotizing enterocolitis (NEC); Neonatal jaundice and kernicterus; Developmental delay and cerebral palsy; Congenital heart disease; Renal dysfunction; Liver dysfunction; Immunodeficiency; Neonatal death; Stillbirth; Long-term neurodevelopmental impairment; Future pregnancy complications; Maternal coagulopathy complications; Postpartum hemorrhage
Section 5: Follow-up Tests
- Neonatal Follow-up Tests: Blood cultures and sensitivity testing (if infection suspected); Complete blood count (CBC) with differential; Neonatal sepsis workup (procalcitonin, CRP); Liver function tests; Renal function tests (creatinine, BUN); Blood glucose monitoring; Coagulation studies (PT, PTT, fibrinogen); Bilirubin levels (total and direct); Blood gas analysis (ABG); Chest X-ray (if respiratory distress); Head ultrasound or MRI (if neurological concerns); Viral serology and PCR (if congenital infection suspected); Genetic testing/karyotype (if chromosomal abnormalities suspected)
- Maternal Follow-up Testing: Coagulation studies (PT, PTT, fibrinogen); Platelet count; Liver function tests (ALT, AST, bilirubin); Renal function (creatinine, BUN); Blood pressure monitoring; 24-hour urine protein (if preeclampsia suspected); Thrombophilia workup (if recurrent pregnancy loss); Antiphospholipid antibody testing (anticardiolipin, anti-β2 glycoprotein I, lupus anticoagulant); Blood cultures (if maternal infection suspected); Maternal serologies for specific infections; Blood glucose testing (if diabetes suspected)
- Specialized Testing Based on Findings: Placental pathology consultation; Genetic counseling and testing; Infectious disease specialist consultation; Immunological studies (if autoimmune cause suspected); Flow cytometry (if hemolytic disease); Direct antiglobulin test (DAT/Coombs); Kleihauer-Betke test (for fetal-maternal hemorrhage); Molecular testing for genetic abnormalities; Specialized imaging (fetal MRI, advanced ultrasound); Contamination cultures from delivery
- Long-term Monitoring and Evaluation: Neonatal neurodevelopmental follow-up at 6 months, 1 year, 2 years; Assessment for cerebral palsy and developmental delays; Hearing and vision screening; Growth monitoring; Infectious disease follow-up (if congenital infection); Ongoing pediatric care and immunization considerations; School-age developmental assessment; Educational evaluation if neurodevelopmental concerns; Maternal follow-up for management of underlying conditions (diabetes, hypertension, thrombophilia); Family planning consultation before subsequent pregnancy
- Complementary Diagnostic Tests: Amniotic fluid analysis (if available); Umbilical cord blood gas and lactate; Fetal autopsy (if fetal death); Placental immunohistochemistry; Placental electron microscopy; Placental culture for bacteria, fungi, viruses; Placental PCR for infectious organisms; Placental cytogenetics; Radiographic studies of skeletal abnormalities
Section 6: Fasting Required?
- Fasting Requirement: NO - Fasting is not required for this test. The specimen is tissue obtained directly from the placenta and umbilical cord at delivery and does not require blood draws or special maternal dietary preparations.
- Specimen Collection Requirements: Immediate collection after placental delivery (within 30 minutes of expulsion); Sterile technique for collection; Appropriate preservation media based on testing type: 10% neutral buffered formalin for histology (minimum 1:10 ratio of fixative to tissue); Sterile, non-bacteriostatic saline for microbiology; Sterile containers or special media if specific cultures needed (bacterial, fungal, viral); Room temperature transport for histology specimens; Refrigerated transport for microbiology specimens; Minimal handling to prevent contamination; Proper labeling with patient identifiers; Specimens should not be frozen unless specifically directed by laboratory
- Special Preparation Instructions: Maternal notification regarding placental pathology testing; Informed consent if autopsy tissue analysis planned; Documentation of clinical history relevant to testing; Specify particular concerns or suspected diagnoses to laboratory; Coordinate with obstetric team and pediatrics for urgent testing if applicable; Ensure clear communication about testing methodologies needed; Clarify timing expectations for results (histology typically 3-7 days, cultures 3-7 days, specialized testing may take longer)
- Medications - No Restrictions: No medications need to be avoided or discontinued prior to placental biopsy; Maternal medications during pregnancy do not affect tissue analysis; Continue all regularly prescribed medications through delivery; Continue any delivery/postpartum medications as prescribed by obstetric team
- Additional Patient Information: No pain or discomfort to patient (performed after delivery); No anesthesia required; Tissue collection is a standard procedure in high-risk deliveries; Patient should be informed about the reason for testing; Results and implications should be discussed with healthcare provider; Genetic counseling may be recommended depending on findings; Implications for future pregnancies should be discussed; Support resources should be provided if adverse findings are identified

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