Placenta
Template: GROSS DESCRIPTION: The specimen is received in a container labelled with the patient's name, who has the initials "[___]" and the specimen site "[___]". Received: Fresh Cord: Insertion: [Paracentrally inserted, 7.5 cm from the edge of the disc, eccentric if closer to edge] Length: [___] cm Diameter: [___] cm Number of vessels: [___] Placenta: Type: Singleton Membranes: [Appears to be complete with marginal insertion. The point of rupture is 2 cm from the edge of the disc. Post fixation the membranes are tan and somewhat translucent] Weight: [___] g, trimmed Size: [___] cm Fetal Surface: [Unremarkable], chorionic plate measures [16.0 x 12.5] cm Maternal Surface: [Complete] Fibrin/Infarcts: [Less than 1%] Percentage of parenchyma with infarct: <1%, if present Representative sections: 1A-membranes and cord 1B-1D-disc, central full thickness adjacent to cord insertion site 1E-maternal surface en face
Notes: No need to take peripheral sections in a grossly normal placenta, they want to mostly see around where the cord inserts. if any infarcts/parenchymal nodules/ other gross findings, submit in 1C, 1D in place of normal/central disk
CHEO
Received [fresh or frozen or formalin] is a [singleton, twin, triplet, quadruplet, quintuplet, sextuplet, etc] placental disc with cord and membranes [attached,partially torn, torn, separate], [and also a separate segment of cord]. Cord: [central, paracentral, excentric, very excentric, marginal, velamentous, furcate, unsupported vessels intact, disrupted insertion]; [ ] length x [ ] diameter cm; [none ,mild, moderate, marked] twisting; [3 or 2] vessels; [True knot, false knot(s)] at [ ] cm and [ ] cm from the insertion; localized cord hemorrhage (edema) at [ ]cm and [ ] cm from the insertion; focal disruption of cord at [ ] cm from the insertion. The separate segment of cord measures [ ] length cm x [ ] diameter cm; is [not ,mildly, moderately, markedly] twisted, and contains [3 or 2] vessels. Membranes: [marginal, circummarginate, circumvallate: give portion/percent of perimeter involved, with greatest extent inward in cm] insertion; tear at [ ] cm from the closest margin; [shiny and pink , blue, greenish, yellowish, whitish, dull, necrotic] discolouration of the amnion; [recent ,old ] retromembranous hemorrhage [hematoma] measuring [ ] x [ ] x [ ] cm, [with ,without] extension onto the disc [decidua]
QCH TWINS
The specimen is received in a container labelled with the patient's name whose initials are "[]" and "[]". Received: [Fresh for in formalin ] Weight: [With cord and membranes removed ] g Type: [Singleton, twin ( dichorionic diamnionic,, monochorionic diamniotic, monochorionic monoamniotic) ] Size: [] cm Membranes: [Appearance, translucent, gray, opaque; complete; comment if opaque, green or brown, presence of meconium, greenish black to light brown, odorless tarry consistency, look for whitish punctate foci on fetal surface of membranes, comment whether they are easily removed by abrasion ] Insertion of membranes: [Marginal, circum-marginate, circumvallate ] Point of rupture: [Measure closest distance to the edge of the disc ] Cord: [Attached, detached ] Insertion: [Central, paracentral, marginal, velamentous ] Length: [] cm Diameter: [] cm Number of vessels: [] Coiling: [absence or prescence/grade] Other: [Presence of knot ] Fetal Surface: [presence of meconium, amnion nodosum, with history of oligohydramnios ] Maternal Surface: [Cotyledons intact, completeness, ragged, partially separated, presence of blood clot either attached, detached or adherent, resulting in depression of the cotyledons ] Fibrin/Infarcts: [Presence or absence of fibrin, infarcts measure largest] Percentage of parenchyma with infarct: [grade percentage of total placental volume affected ] Other: [eg all Twins, indicate if vascular connection is identified]
FUSED TWIN
The specimen is received in a container labelled with the patient's name whose initials are "[]" and "[]". Received: [Fresh for in formalin ] Type: [dichorionic diamnionic,, monochorionic diamniotic, monochorionic monoamniotic] Weight: [With cord and membranes removed ] g Size: [overall] cm TWIN A: Membranes: [Appearance, translucent, gray, opaque; complete; comment if opaque, green or brown, presence of meconium, greenish black to light brown, odorless tarry consistency, look for whitish punctate foci on fetal surface of membranes, comment whether they are easily removed by abrasion ] Insertion of membranes: [Marginal, circum-marginate, circumvallate ] Point of rupture: [Measure closest distance to the edge of the disc ] Cord: [Attached, detached ] Insertion: [Central, paracentral, marginal, velamentous ] Length: [] cm Diameter: [] cm Number of vessels: [] Coiling: [absence or prescence/grade] Other: [Presence of knot ] Fetal Surface: [presence of meconium, amnion nodosum, with history of oligohydramnios ] Maternal Surface: [Cotyledons intact, completeness, ragged, partially separated, presence of blood clot either attached, detached or adherent, resulting in depression of the cotyledons ] Fibrin/Infarcts: [Presence or absence of fibrin, infarcts measure largest] Percentage of parenchyma with infarct: [grade percentage of total placental volume affected ] TWIN B: TWIN A: Membranes: [Appearance, translucent, gray, opaque; complete; comment if opaque, green or brown, presence of meconium, greenish black to light brown, odorless tarry consistency, look for whitish punctate foci on fetal surface of membranes, comment whether they are easily removed by abrasion ] Insertion of membranes: [Marginal, circum-marginate, circumvallate ] Point of rupture: [Measure closest distance to the edge of the disc ] Cord: [Attached, detached ] Insertion: [Central, paracentral, marginal, velamentous ] Length: [] cm Diameter: [] cm Number of vessels: [] Coiling: [absence or prescence/grade] Other: [Presence of knot ] Fetal Surface: [presence of meconium, amnion nodosum, with history of oligohydramnios ] Maternal Surface: [Cotyledons intact, completeness, ragged, partially separated, presence of blood clot either attached, detached or adherent, resulting in depression of the cotyledons ] Fibrin/Infarcts: [Presence or absence of fibrin, infarcts measure largest] Percentage of parenchyma with infarct: [grade percentage of total placental volume affected ] Other: [eg all Twins, indicate if vascular connection is identified] Representative sections: A1–twin A cord x 2 and membranes A2, A3–twin A placental disc including both fetal and maternal surfaces A4–twin B cord x 2 and membranes A5, A6–twin B placental disc including both fetal and maternal surfaces A7–roll of separating membranes
TWIN SEPARATE
The specimen is received in a container labelled with the patient's name whose initials are "[]" and "[]". Received: [Fresh for in formalin ] Type: [dichorionic diamnionic,, monochorionic diamniotic, monochorionic monoamniotic] Weight: [With cord and membranes removed ] g Size: [overall] cm TWIN A: Weight: [With cord and membranes removed ] g Size: [overall] cm Membranes: [Appearance, translucent, gray, opaque; complete; comment if opaque, green or brown, presence of meconium, greenish black to light brown, odorless tarry consistency, look for whitish punctate foci on fetal surface of membranes, comment whether they are easily removed by abrasion ] Insertion of membranes: [Marginal, circum-marginate, circumvallate ] Point of rupture: [Measure closest distance to the edge of the disc ] Cord: [Attached, detached ] Insertion: [Central, paracentral, marginal, velamentous ] Length: [] cm Diameter: [] cm Number of vessels: [] Coiling: [absence or prescence/grade] Other: [Presence of knot ] Fetal Surface: [presence of meconium, amnion nodosum, with history of oligohydramnios ] Maternal Surface: [Cotyledons intact, completeness, ragged, partially separated, presence of blood clot either attached, detached or adherent, resulting in depression of the cotyledons ] Fibrin/Infarcts: [Presence or absence of fibrin, infarcts measure largest] Percentage of parenchyma with infarct: [grade percentage of total placental volume affected ] TWIN B: Weight: [With cord and membranes removed ] g Size: [overall] cm Membranes: [Appearance, translucent, gray, opaque; complete; comment if opaque, green or brown, presence of meconium, greenish black to light brown, odorless tarry consistency, look for whitish punctate foci on fetal surface of membranes, comment whether they are easily removed by abrasion ] Insertion of membranes: [Marginal, circum-marginate, circumvallate ] Point of rupture: [Measure closest distance to the edge of the disc ] Cord: [Attached, detached ] Insertion: [Central, paracentral, marginal, velamentous ] Length: [] cm Diameter: [] cm Number of vessels: [] Coiling: [absence or prescence/grade] Other: [Presence of knot ] Fetal Surface: [presence of meconium, amnion nodosum, with history of oligohydramnios ] Maternal Surface: [Cotyledons intact, completeness, ragged, partially separated, presence of blood clot either attached, detached or adherent, resulting in depression of the cotyledons ] Fibrin/Infarcts: [Presence or absence of fibrin, infarcts measure largest] Percentage of parenchyma with infarct: [grade percentage of total placental volume affected ] Other: [eg all Twins, indicate if vascular connection is identified] Representative sections: A1–twin A cord x 2 and membranes A2, A3–twin A placental disc including both fetal and maternal surfaces A4–twin B cord x 2 and membranes A5, A6–twin B placental disc including both fetal and maternal surfaces A7–roll of separating membranes