Diagnostic Pathology: Placenta

SECTION 1: OVERVIEW OF GROSS AND MICROSCOPIC CHANGES UMBILICAL CORD 4 Gross Evaluation and Normal Histology of Umbilical Cord Amy Heerema-McKenney, MD and Edwina J. Popek, DO 14 Umbilical Cord Coiling 18 Knots Linda M. Ernst, MD, MHS 22 Umbilical Cord Edema and Thinning Linda M. Ernst, MD, MHS and Amy Heerema-McKenney, MD 26 Histopathologic Changes of Umbilical Cord Amy Heerema-McKenney, MD EXTRAPLACENTAL MEMBRANES 32 Gross Evaluation and Normal Histology of Membranes Amy Heerema-McKenney, MD 36 Histopathologic Changes of Membranes Amy Heerema-McKenney, MD CHORIONIC PLATE 42 Gross Evaluation and Normal Histology of Chorionic Plate Linda M. Ernst, MD, MHS 48 Histopathologic Changes of Chorionic Plate Amy Heerema-McKenney, MD STEM VILLI 52 Gross Evaluation and Normal Histology of Stem Villi Amy Heerema-McKenney, MD 54 Histopathologic Changes of Stem Villi Amy Heerema-McKenney, MD CHORIONIC VILLI 58 Gross Evaluation and Normal Histology of Chorionic Villi Amy Heerema-McKenney, MD 64 Histopathologic Changes of Chorionic Villi Amy Heerema-McKenney, MD SECTION 2: PLACENTAL DIAGNOSES SEPTA, INTERVILLOUS SPACE, AND BASAL PLATE 72 Gross Evaluation and Normal Histology of Septa, Intervillous Space, and Basal Plate Amy Heerema-McKenney, MD 74 Histopathologic Changes of Septa, Intervillous Space, and Basal Plate Amy Heerema-McKenney, MD DECIDUA 76 Gross Evaluation and Normal Histology of Decidua Amy Heerema-McKenney, MD 80 Histopathologic Changes of Decidua Amy Heerema-McKenney, MD MECONIUM 86 Meconium-Stained Placenta Amy Heerema-McKenney, MD INTRAUTERINE INFLAMMATION/INFECTION 90 Patterns of Ascending Amniotic Fluid Infection Edwina J. Popek, DO 98 Group B Streptococcus Edwina J. Popek, DO 102 Escherichia coli 104 Listeria monocytogenes 108 Fusobacterium Species and Other Anaerobic Bacteria 112 Other Bacterial and Mycobacterial Species Edwina J. Popek, DO 118 Candida Edwina J. Popek, DO PLACENTAL INFECTIONS WITH VILLITIS AND OTHER FINDINGS 122 Cytomegalovirus Edwina J. Popek, DO 128 Parvovirus B19 Edwina J. Popek, DO 134 Herpes Simplex Virus Edwina J. Popek, DO 140 Other Herpes Viruses 144 SARS-CoV-2 (COVID-19) 148 Other Viruses Edwina J. Popek, DO 156 Syphilis Edwina J. Popek, DO 160 Coccidioidomycosis Amy Heerema-McKenney, MD 162 Parasites Edwina J. Popek, DO CHRONIC INFLAMMATORY LESIONS 168 Cellular Composition of Chronic Inflammatory Lesions Philip J. Katzman, MD 170 Chronic Villitis Philip J. Katzman, MD and Amy Heerema-McKenney, MD 176 Chronic Histiocytic Intervillositis Philip J. Katzman, MD and Amy Heerema-McKenney, MD 178 Basal Chronic Villitis and Chronic Deciduitis Philip J. Katzman, MD 182 Chronic Chorioamnionitis and Chorionic Histiocytic Hyperplasia Philip J. Katzman, MD and Amy Heerema-McKenney, MD 186 Eosinophilic/T-Cell Chorionic Vasculitis Philip J. Katzman, MD MASSIVE PERIVILLOUS FIBRIN DEPOSITION AND MATERNAL FLOOR INFARCTION 190 Massive Perivillous Fibrin Deposition and Maternal Floor Infarction Linda M. Ernst, MD, MHS FETAL VASCULAR MALPERFUSION 196 Large Vessel Fetal Vascular Malperfusion Linda M. Ernst, MD, MHS 204 Distal Villous Lesions of Fetal Vascular Malperfusion Linda M. Ernst, MD, MHS MATERNAL VASCULAR MALPERFUSION 208 Small-for-Gestational-Age Placenta Eileen Margaret McKay, MD 212 Accelerated Villous Maturation 216 Distal Villous Hypoplasia Amy Heerema-McKenney, MD 220 Decidual Arteriopathy Amy Heerema-McKenney, MD 224 Infarcts Amy Heerema-McKenney, MD 228 Acute Abruption and Retroplacental Hematoma Eileen Margaret McKay, MD 234 Chronic Abruption Eileen Margaret McKay, MD VILLOUS HYPERVASCULAR LESIONS 238 Chorangiosis Jason A. Jarzembowski, MD, PhD 240 Chorangiomatosis Jason A. Jarzembowski, MD, PhD 242 Chorioangioma Jason A. Jarzembowski, MD, PhD GESTATIONAL TROPHOBLASTIC DISEASE, RELATED LESIONS, AND OTHER TUMORS 246 Hydropic Degeneration Edwina J. Popek, DO 254 Partial Hydatidiform Mole Edwina J. Popek, DO and Amy Heerema-McKenney, MD 262 Complete Hydatidiform Mole Edwina J. Popek, DO 272 Gestational Choriocarcinoma Edwina J. Popek, DO 276 Placental Site Nodule Edwina J. Popek, DO and Amy Heerema-McKenney, MD 282 Exaggerated Placental Site 286 Placental Site Trophoblastic Tumor Edwina J. Popek, DO and Amy Heerema-McKenney, MD 292 Epithelioid Trophoblastic Tumor 296 Metastatic Tumors Jason A. Jarzembowski, MD, PhD and Edwina J. Popek, DO 302 Uterine Tumors Associated With Placenta Amy Heerema-McKenney, MD PLACENTAL MESENCHYMAL DYSPLASIA 304 Placental Mesenchymal Dysplasia Amy Heerema-McKenney, MD SECTION 3: PLACENTAL EVALUATION IN SPECIAL CIRCUMSTANCES DIABETES IN PREGNANCY AND MATERNAL OBESITY 310 Diabetes and Obesity in Pregnancy Amy Heerema-McKenney, MD and Edwina J. Popek, DO 314 Placentomegaly Eileen Margaret McKay, MD 318 Delayed Villous Maturation Eileen Margaret McKay, MD PREECLAMPSIA AND MATERNAL VASCULAR MALPERFUSION 320 Preeclampsia and Related Hypertensive Disorders Eileen Margaret McKay, MD 326 DEL_Extravillous Trophoblast Cysts Amy Heerema-McKenney, MD 330 DEL_Laminar Decidual Necrosis Amy Heerema-McKenney, MD FETAL-MATERNAL HEMORRHAGE 334 Fetal-Maternal Hemorrhage Amy Heerema-McKenney, MD FETAL HYDROPS 338 Hemolytic Disease of Newborn 342 Non-Immune-Mediated Hydrops INTRAUTERINE GROWTH RESTRICTION 346 Placental Causes of Poor Fetal Growth Linda M. Ernst, MD, MHS PREMATURITY 350 Placental Findings in Premature Birth Amy Heerema-McKenney, MD ABNORMAL PLACENTAL IMPLANTATION 352 Placenta Accreta Edwina J. Popek, DO 362 DEL_Fallopian Tubes: Ectopic Pregnancy and Other Changes INTRAUTERINE FETAL DEMISE 366 1st-Trimester Pregnancy Loss Amy Heerema-McKenney, MD and Edwina J. Popek, DO 374 2nd-Trimester Fetal Demise Amy Heerema-McKenney, MD and Edwina J. Popek, DO 382 3rd-Trimester Fetal Demise Amy Heerema-McKenney, MD 388 Recurrent Pregnancy Loss Amy Heerema-McKenney, MD 390 In Utero Demise-to-Delivery Interval Changes Amy Heerema-McKenney, MD 392 Hypoxic-Ischemic Encephalopathy Edwina J. Popek, DO MULTIPLE GESTATIONS 402 Complications of Monochorionic Monoamniotic Twin Gestations Jason A. Jarzembowski, MD, PhD and Edwina J. Popek, DO 408 Twin Growth Discrepancy Monique E. De Paepe, MD, MSc 410 Twin-Twin Transfusion Syndrome Monique E. De Paepe, MD, MSc 414 Twin Anemia-Polycythemia Sequence Monique E. De Paepe, MD, MSc 416 After In Utero Intervention for Twin-Twin Transfusion Syndrome Monique E. De Paepe, MD, MSc 418 Triplet and Higher Order Placenta Monique E. De Paepe, MD, MSc MATERNAL COMPLICATIONS OF PREGNANCY 422 Maternal Mortality Edwina J. Popek, DO 432 Evaluation of Postpartum Hysterectomy Edwina J. Popek, DO 440 Postpartum Hemorrhage Edwina J. Popek, DO SECTION 4: APPENDIX REFERENCE CHARTS FOR PLACENTAL EVALUATION 452 Weights for Singleton Placentas Amy Heerema-McKenney, MD 453 Weights for Twin Placentas Amy Heerema-McKenney, MD 454 Weights for Triplet Placentas Amy Heerema-McKenney, MD 455 Reference Values for Fetal and Placental Growth in Early Pregnancy Amy Heerema-McKenney, MD SAMPLE TEMPLATES FOR PLACENTAL EVALUATION 456 Singleton Placenta Gross Evaluation Amy Heerema-McKenney, MD 457 Twin Placenta Gross Evaluation Amy Heerema-McKenney, MD 458 Placenta Microscopic Evaluation Amy Heerema-McKenney, MD 461 Placenta Triage Amy Heerema-McKenney, MD