Appendix

Abbreviations

ACLA anticardiolipin antibodiesAEDF absent end-diastolic flowAFI amniotic fluid indexAFLP acute fatty liver of pregnancyAGA appropriate for gestational ageAPLA antiphospholipid antibodiesAROM artificial rupture of membranesART assisted reproductive technologyBPD biparietal diameterBPP biophysical profileBTBV beat-to-beat variabilityCPD cephalopelvic disproportionCPM confined placental mosaicismCS cesarean sectionCVS chorionic villus samplingEDC estimated date of “confinement”EDD estimated date of deliveryEFW estimated fetal weightEGA estimated gestational ageFGR fetal growth restrictionFHR fetal heart rateFLM fetal lung maturityFM fetal movementFMH fetomaternal hemorrhageFW fetal weightGBBS group B beta StreptococcusGBS group B StreptococcusGDM gestational diabetes mellitusGDMA1 non-insulin-dependent diabetes mellitusGDMA2 insulin-dependent diabetes mellitusGTD gestational trophoblastic disease

484 Appendix

GxPxxxx gravity, parity; numbers after parity indicate—term,preterm, abortion, living

HELLP hemolysis, elevated liver enzymes, low plateletshPL human placental lactogenICSI intracytoplasmic sperm injection,IDM infant of diabetic motherIUFD intrauterine fetal demiseIUGR intrauterine growth restriction (formerly “retardation”)IUP intrauterine pregnancyIVDA intravenous drug abuseIVF in vitro fertilizationLAC lupus anticoagulantLFCS low flap cesarean sectionLGA large for gestational ageLOF low outlet forcepsLTCS low transverse cesarean sectionMFI maternal floor infarctionMSAFP maternal serum alpha fetoproteinMSF meconium-stained (amniotic) fluidNIHF nonimmune hydrops fetalisNRNST nonreactive nonstress testNST nonstress test; antenatal test of fetal well-beingNSVD normal spontaneous vaginal deliveryOA occiput anterior (presenting part)OCT oxytocin challenge testOP occiput posterior (presenting part)PEC preeclampsiaPET preeclampsia, toxemiaPIH pregnancy-induced hypertensionPLAP placental alkaline phosphatasePNC prenatal carePPROM preterm premature rupture of membranes; may be pro-

longed (>24 hours) as wellPROM preterm (prior to term) or premature (prior to labor) rupture

of membranesPTL preterm laborPUBS percutaneous umbilical blood samplingPUPPP pruritic urticarial papules and plaques of pregnancyREDF reversed end-diastolic flowSGA small for gestational ageSROM spontaneous rupture of membranesSVD spontaneous vaginal deliveryTTTS twin-to-twin transfusion syndromeUC uterine contractionsUC umbilical cordUPD uniparental disomyUS ultrasoundVAVD vacuum-assisted vaginal deliveryVBAC vaginal birth after cesarean deliveryVtx vertex presentation of the fetus during delivery.VUE villitis of unknown etiology

Clinical Terms

Amnioinfusion Fluid, usually saline, injected intraamniotically in situations with thick meconium in an attempt to dilute the meconium.Apgar scores Evaluation of infant after delivery and used as a pre-dictor of fetal well-being. Commonly done at 1 and 5min. Zero, one,or two points given for color, tone, cry, respiratory effort, and reflexirritability.Biophysical profile Test of fetal well-being. Includes nonstress test(NST, see below) and assessment of amniotic fluid volume. Highest is10; 7 and above is considered reassuring.Beat-to-beat variability In fetal heart monitoring. Normally strip should show a certain amount of variability in rate from beat tobeat. Lack of this variability is an indication of “nonreassuring fetalstatus.”Cord prolapse When the cord is the presenting part and precedes thefetus during delivery. Results in cord occlusion if the head is allowedto compress the cord against the cervix.Deceleration Fetal heart monitoring abnormality. May be early, vari-able, or late. Variable usually considered due to cord compression. Latedecelerations commonly thought to be “uteroplacental insufficiency”and are ominous findings.Doppler velocimetry Studies of blood flow, usually through theumbilical artery, to measure systolic and diastolic flow (see end-diastolic flow).End-diastolic flow End-diastolic blood flow through the umbilicalartery may be absent or reversed with significant placental malperfu-sion. Absent or reversed EDF has been associated with IUGR and pooroutcome.Incompetent cervix Defined as painless cervical dilation in thesecond trimester or early third trimester, with prolapse and ballooningof the membranes into the vagina, followed by ruptured membranesand delivery. Often recurs and is maybe due to an anatomical defect.L/S ratio Lecithin/sphingomyelin ratio, used to evaluate fetal lungmaturity, measured on samples of amniotic fluid.Nonstress test Evaluation of fetal well-being by assessment of fetalheart rate acceleration detected by Doppler coordinated with fetalmovements as perceived by the mother. It is a test of fetal well-being.Placenta previa Placental implantation over the cervical os, may bepartial.Percutaneous umbilical cord sampling Sampling of fetal blood byintroduction of a needle through the abdomen into the umbilical cord.Quadruple screen Prenatal screen for anomalies performed onmaternal serum; includes beta-hCG, estriol, alpha fetoprotein, anddimeric alpha inhibin; reported as multiples of the median.Stress test Also called contraction stress test, is a test of uteroplacen-tal function. Contractions are enhanced by IV oxytocin and fetal heartrate is monitored. A positive or abnormal test is when fetal heart ratedecelerations are noted.Tocolysis Use of various drugs to inhibit preterm labor.

Clinical Terms 485

Triple screen Prenatal screen for anomalies performed on maternalserum. Includes beta-hCG, estriol, and alphafetoprotein. Reported asmultiples of the median.Twin peak sign Peak seen on the fetal surface of twin placentas thatrepresents the fibrin ridge seen between fused diamnionic-dichorionictwin placentas.Vasa previa Velamentous vessels over cervical os.

486 Appendix

hemosiderin associated with, 236

medicolegal aspects of, 472placental examination in, 30and retroplacental hematoma,

340, 341, 342, 355–357Abscess, intervillous, 40, 60,

291–292Accessory lobe, 210–211Actinomyces infection, 314Acute chorioamnionitis. See

Chorioamnionitis, acuteAcute fatty liver of pregnancy, 321,

329ADAM complex, 243Adenoma, hepatocellular, 411Adrenal gland, heterotopic, 411Adrenal vein, fetal, thrombosis of,

325Age

gestationalof aborted embryo or fetus, 4correlation with fetal foot

length, 18, 42–43correlation with fetal size, 21,

42–43effect on umbilical cord length,

256in spontaneous abortion,

176–177maternal, 466

as spontaneous abortion riskfactor, 176–177

Agglutination, villous, 339Alcohol abuse, maternal, 327,

330Alkylating agents, 328Allantoic duct, remnants of,

249–250Allantois

blood vessels of, 77, 79

AAbdominal circumference, fetal, 18Abdominal wall defect, limb-body

wall complexassociated in,244, 245

ABO incompatibility, 372Abortion, 173-189

Induced/therapeuticclinical features of, 174criminal

complications of, 174definition of, 173fetal reconstruction after, 16,

17methods of, 12, 174, 175pathologic features of, 174–175products of conception

analysis in, 7, 12–13septic, 174

spontaneousantiphospholipid antibodies

associated, 348in infection

candidiasis, 295chlamydial infection, 295

chromosomal anomalies, 6–7,176–177, 181–185

coiled umbilical cordassociated, 254

definition of, 173, 175fetal reconstruction after, 16,

17–19incidence of, 178incomplete, 14

definition of, 173inevitable, 14in lupus anticoagulant, 346maternal age-related, 176–177in maternal diabetes mellitus,

324missed, 14

Breus’ mole associated with, 233

definition of, 173and subchorionic hematoma,

232and thalassemia, 323threatened, 14

definition of, 173umbilical cord-associated, 254

recurrent/habitual, 14infection-associated

Campylobacter infection, 314Ureaplasma infection, 294

and chronic intervillositis, 313

cytogenetic analysis of, 7definition of, 173, 178, 180etiology of, 180–181and villitis of unknown origin,

311Abortus. See also Fetus; Products of

conceptionhydropic, 62, 179, 180

differentiated fromhydatidiform mole, 429, 430

Abruptio placentacauses of, 355alcohol abuse, 327

cocaine use, 327–328hypothyroidism, 324lupus anticoagulant, 348multiple pregnancy, 142pheochromocytoma, 326–327placenta previa, 220preeclampsia, 340scleroderma, 320smoking, 327trauma, 355

“concealed,” 355definition of, 340, 355

Index

488 Index

Alloisoimmunization, maternal,324, 376–377. See also Rhincompatibility

in fetomaternal hemorrhage, 379

Alpha-fetoproteinin chromosomalanomalies, 187

in fetomaternal hemorrhage, 380in fetus papyraceous, 153in maternal floor infarction, 367in placenta accrete, 198in subchorionic hematoma, 232measurement of, 186

Altitude. See High altitudeAmenorrhea, in placental site

trophoblastic tumor, clinicalfeatures, 451

Aminopterin, 328Amniocentesis

and abruptio placenta, 355and fetomaternal hemorrhage,

378and retromembranous

hematoma, 230as twin-to-twin transfusion

syndrome treatment, 166Amniogenic cells, 74, 77Amnion

attachment to chorionic plate,122

bacterial cultures of, 33cysts of, 34, 54, 223, 224, 225development of, 69, 71, 78as fetal membrane component,

49–50functions of, 89in gastroschisis, 239incomplete fusion with chorion,

77lesions of, 34-35, 54-57meconium-induced degeneration

of, 235metaplasia, squamous, of, 240necrosis of, in herpes simplex

virus infection, 302, 303nutrition of, 50oxygen supply to, 50rupture of, 121, 214–215, 244–245,

247structure of, 88, 89

during second and thirdtrimesters, 45, 46, 49–50

tumors of, 226vacuolization of, 239, 382–383

Amnionic bands, 34, 243–248clinical features of, 245–248and fetal amputation, 243,

246–247pathogenesis of, 243pathologic features of, 244–245

Amnionic cavity, development of,74, 77, 78

Amnionic sheets, 243, 244Amnionic vesicles, 75, 77Amnion nodosum, 34, 56,

240–243in acardiac twins, 158clinical features of, 241pathogenesis of, 240–241pathologic features of, 241,

242–243Amniorrhea, 216Amniotic fluid, 89–90

constituents of, 90pH regulation in, 89sources of, 89vernix caseosa in, 228–229, 230volume of, 89–90

Amnionic sac infection syndrome,280. See alsoChorioamnionitis, acute

Amputation fetalamnionic bands-associated, 243,

246–247necrosis, 401

Anastomosis, vascular, in twin placentas, 145–146, 163,

467, 468in acardiac twins, 156in twin-to-twin transfusion

syndrome, 163laser coagulation of, 166, 477

of umbilical arteries, 269Anemia

fetal/neonatal, 355, 471and fetomaternal hemorrhage,

379, 466nucleated red blood cells in,

381villous tissue in, 40

maternal, 323, 329chorangiosis associated, 359hemolytic, 346sickle cell, 322–323, 329, 376thalassemia, 375

Aneuploidy, 181, 188, 479Aneurysm, of umbilical vessels, 58,

471Angiogenesis, fetoplacental, 36,

342–343Angioma, of umbilical cord,

271–272Angiomyxoma, 405Anovulation, hypothyroidism-

associated, 324Antibodies. See also specific

antibodiesmaternal, in immune hydrops

fetalis, 371–372anticardiolipin 347

antinuclear antibodies (ANA),232, 346

antiphospholipid antibodies, 177,347–348

lupus anticoagulant antibodies,346

Anticoagulants, 348Anticytokeratin, 54Antiphosphatidylserine, 347Anti-proliferating cell nuclear

antigen (PCNA), 55Antithrombin III deficiency, 348Antivimentin, 55Aorta

stenosis of, 321thrombosis of, 348

Apgar score, 466Apoptotic knots, 84Apt test, 380Arias-Stella change, 114, 115Arrhythmias, fetal, 379Arterioles, decidual. See

Vasculopathy, decidualArteriolopathy, decidual. See

Vasculopathy, decidualArteriopathy, decidual. See

Vasculopathy, decidualArthrogryposis, 18–19Aspiration, of meconium, 238, 470Aspirin, as antiphospholipid

antibodies therapy, 348Assisted reproductive technology

(ART), 69, 466, 476Atherosis, decidual, 358

differentiated from thromboticthrombocytopenic purpura,323–324

in preeclampsia, 333–334, 335in thrombophilia, 349

Autoimmune diseases, maternal,320

and maternal blood chimerism,478

villitis of unknown etiologyassociated with, 311

Autolysis, of fetal tissues, 16,18–19, 474

Automobile accidents, as abruptioplacenta cause, 355

BBabesiosis, 317Bacteria. See also specific bacteria

cultures, 20, 33stains for, 53–54infections, 288–296, 314. See also

specific bacteriaplacental odor associated with, 27in postpartum endometritis, 196Bacteroides infection, 282, 288, 314

Index 489

Bart’s hemoglobin disease, 376Basal lamina

incomplete, 124as placental barrier component,

73Basal plate, 53, 64–65, 107

composition of, 10, 11–12, 31definition of, 11, 72–73, 124development of, 70, 72–73,

124–125extravillous trophoblast in, 108fibrin and fibrinoid content of,

64, 116, 117, 120macroscopic examination of, 31lesions of, 38–39, 64–65of term placenta, 49, 125–128in villitis of unknown etiology,

309Basement membrane

amnionic epithelial, 89trophoblastic, 80, 81, 85

calcified, 120, 387, 388villous, melanin deposits in, 121

Beckwith-Wiedemann syndrome,62, 368, 377–378

Bilirubinfetal, 236, 237–238, 238maternal, 321

Blastocystcavity, 69development of, 69implantation of, 71, 476multiple, 476trophoblastic covering of, 70, 71

Blastomyces, 315associatedassociatedassociated-

associatedBone, embryonicrests of, 227

Bone, fetal retained, 175Bony anomalies

In amnionic band/sheet, 244evaluation of, 19

Borrelia infection, 315Bouin’s solution, 32–33Brain. See also Central nervous

systemcocaine-associated infarction of,

328herpes simple virus infection of,

303tumors, congenital, 413

Breus’ mole, 232–233differentiated from subchorionic

hematomas, 232–233in spontaneous abortion, 184

CCalcification, 120

of chorangioma, 410in fetal storage disorders, 382

of fetal vascular placental bloodvessel thrombi, 393, 394, 395,396

in herpes simplex virus infection,303

of intimal fibrin/vascularcushions, 398, 399

of maternal placental surface, 38and maternal smoking, 327in mucolipidosis type II, 384of trophoblastic basement

membrane, 387, 388of umbilical cord, 36, 56villous, 14, 62, 384of yolk sac remnant, 227, 228

Campylobacter infections, 292, 314Candidiasis, 275, 288

congenital, 295–297of umbilical cord, 36, 56vaginal, 295

Capillariesin chorangioma, 358in chorangiomatosis, 358,

360–361, 362, 363in chorangiosis, 358–360development of, 73, 74, 89, 98,

99, 100high altitude-associated changes

in, 323histologic examination of, 53in partial hydatidiform mole,

427placental hypoxia and, 343–344

Capsular decidua. See Deciduacapsularis

Cardiac disorders/diseasesfetal, 472as hydrops fetalis cause, 371maternal, 321, 329

as recurrent/habitual abortioncause, 180

subchorionic hematomasassociated with, 232

Carotid artery, thrombosis of, 348Cartilage, embryonic rests of, 227Cell columns, 11, 73, 107, 133

basal layers of, 110differentiated from cell islands,

132extravillous trophoblast in, 108fibrin and fibrinoid content of,

116, 117in late pregnancy, 49as source of trophoblastic

proliferation, 133–134Cell islands, 11, 47, 107, 131–133

basal layers of, 110composition of, 49cysts of, 224development of, 73

differentiated from cell columns,132

extravillous trophoblast in, 108fibrin and fibrinoid content of,

116, 117during first trimester, 11

Central nervous systeminjuries to, in twins, 467, 477–478mediolegal 466, 468thrombosis of, 401–402

Cerclage, 478Cerebral palsy

and chorangiosis, 360and chorioamnionitis, 280, 468and fetal thrombotic

vasculopathy, 402and fetomaternal hemorrhage,

379and funisitis, 468medicolegal aspects of, 466, 468in twins, 167umbilical cord

entanglement, 258–259venous thrombosis-, 393

Cervixcervicitis, 281incompetenc, 177, 281, 478

Cesarean sectionnuchal cord-associated, 258–259as placenta accreta or percreta

risk factor, 193, 199, 480–481in placenta previa, 220–221as uterine rupture cause, 193

Chest circumference, of second-trimester fetus, 18

Chimerism, 187, 382, 477, 478blood, 168whole body, 167–168

Chlamydial infection, 292, 295Cholestasis, of pregnancy, 321, 329Cholesterol-containing

macrophages, 335Cholesterol ester storage disease,

390Chorangioma, 31, 40, 58, 358, 410

and alcohol use, 327clinical features of, 410as fetal cardiac failure cause, 472pathogenesis of, 405–406pathologic features of, 406–410villi in, 64

Chorangiomatosis, 40, 64, 358,360–361, 362, 363

Chorangiosis, 64, 323, 358–360medicolegal aspects of, 473

Chorioamnionitisacute, 280–288

causal agents, identification of,54

clinical, 281–282

490 Index

Chorioamnionitis (cont.) differentiated from chronic

chorioamnionitis, 288Escherichia coli-associated, 293fetal membranes in, 34and fetal thrombotic

vasculopathy, 401Fusobacterium, 293inflammation associated with, 54listeriosis, 291maternal and fetal responses

in, 284–288medicolegal aspects of, 468necrotizing, herpes simplex

virus infection, 302as perinatal mortality cause,

478–479relationship with streptococcal

infection, 290Ureaplasma infections, 294

chronic, 312–313inflammation associated with, 54in syphilis, 298in villitis of unknown etiology,

312subacute, 283, 288, 289

inflammation associated with,54

Choriocarcinoma, 377, 436–446chemotherapy for, 436clinical features of, 436–438, 444definition of, 436differentiated from

early abortion specimens, 439placental site trophoblastic

tumors, 456, 458hydatidiform mole, as risk factor,

417, 424, 427in situ (placental), 60, 443–444metastatic, 439, 442–443, 444pathologic features of, 438–443,

444–445placental, 60, 443–444

Chorionblood vessels of. See Chorionic

surface vesselsearly rupture of, 214–215incomplete fusion with amnion, 77necrosis of, in herpes simplex

virus infection, 303smooth. See Chorion laevestructure of, 50vascular thrombosis in, 394, 395

Chorion frondosum, 50, 74, 76, 78, 88in circumvallate placenta, 212development of, 74differentiation of, 74, 75

Chorionic plate, 46, 48, 75, 107–108basal layers of, 110development of, 70, 74, 121–122

extravillous trophoblast in, 108first trimester, 8, 9functions of, 107lesions of

macroscopic, 34–35microscopic, 58–59

primary, 70, 72second and third trimester, 29,

31, 45, 46, 48, 53at term, 122–124

Chorionic vesselsentrance into cotyledons, 29histologic examination of, 53macroscopic examination of, 29,

31routine tissue sections of, 32in chorioamnionitis, 287

Chorionic villus sampling (CVS),185–187

for sickle cell disease diagnosis,376

for thalassemia diagnosis, 376Chorion laeve

basal layers of, 110development of, 71, 78structure and histology of, 88, 89,

90–91Chromosomal analysis, 66

in chimerism, 167–168in mosaicism, 33, 168tissue sample preparation for,

33Chromosomal anomalies, 181–187

in fetal specimens, 6–7, 19, 185in hydrops fetalis, 371parental, 181in spontaneous abortion, 6–7,

176–177, 181–185 translocations, 181

Chronic chorioamnionitis. SeeChorioamnionitis, chronic

Circummarginate placenta, 211–215Circumvallate placenta, 211–215Clostridial infection, 282, 294Club foot, 244Coagulation tests, phospholipid-

dependent, 348Cocaine abuse, 327–328, 330Coccidioides immitis infection, 315Collagen, amnionic and chorionic,

50Complement activation, 349Congenital anomalies. See also

specific congenital anomaliesand chorangiomatosis, 361and circumvallate placenta, 214in maternal diabetes mellitus,

324photographic documentation of,

17

in placenta previa, 220as preterm delivery cause, 66in radiation exposure, 328renal, 269and single umbilical artery,

92–93, 269as spontaneous abortion cause,

177in twins, 141umbilical cord insertion patterns

in, 267Connecting stalk, 77, 78Connective tissue

maternal disorders of, 320, 329as placental barrier component,

73of villous stroma, 80, 81, 85

Cordocentesis, adverse effects of,376–377

Corynebacterial infection, 314Cotyledons

absence of, 199, 364 arterial/venous relationship in,

392chorionic blood vessel entrance

into, 29macroscopic examination of, 30,

31of normal placenta, 30

Coxiella burnetii infection, 314Coxsackie virus infection, 177, 314,

315Crown-heel length, 18, 21Crown-rump length, 4, 18, 21, 42Cryopreservation, of fetal

specimens, 7, 19Cryptococcus infection, 315Cushing’s disease, 330CVS. See Chorionic villus sampling

(CVS)Cyclophosphamide, 328Cystic fibrosis, 329Cystinosis, 329Cystinuria, 329Cysts, 34, 223–226

allantoic duct remnant, 250, 251amnionic, 34, 54, 223, 224, 225amnionic epithelial inclusion,

223, 224cell island, 224chorionic, 58embryonic, 56epidermal, 223, 224, 225epidermoid, 54follicular, 423–424omphalomesenteric duct

remnant, 252ovarian, 375, 423in scleroderma, 320septal, 131, 132, 224

Index 491

subamnionic, 306–307subchorionic, 34, 54, 58, 223–224,

225–226, 306–307theca lutein, 375, 423of umbilical cord, 36, 224, 250,

251Cytogenetic analysis, See also

Chromosomal analysisof fetal specimens, 6–7, 19, 185

Cytokeratin, 55, 175, 457–458Cytomegalovirus, 54, 177, 297, 298,

300–302, 469Cytotrophoblast. See also Langhans’

cellsof cell columns, 133of chorionic plate, 121, 123definition of, 71development of, 70, 74in hydrops fetalis, 376as placental barrier component,

73villous. See Langhans’ cells

DDecidua, 3, 5, 6, 91–92, 107–108,

114–115absence of, in placenta accreta,

200, 201, 202basalis,

histologic examination of, 53postpartum, 193retroplacental hematoma,

356–357capsularis, 49, 52, 76, 88, 89,

91–92in chorioamnionitis, 282definition of, 74meconium staining of, 236preeclampsia-related vascular

changes in, 337relation with extravillous

trophoblast, 174–175deficient, 199eclampsia-associated vascular

changes in, 333–337development of, 72differentiation from extravillous

trophoblast, 174–175in intrauterine pregnancy, 174necrosis of, 34, 38, 64, 124–125,

175, 335, 336, 353parietal (decidua vera), 74,

91–92in placental septa, 129, 131physiologic conversion failure in,

119, 333–334in preeclampsia, 333–335subdivisions of, 74trophoblastic invasion of,

124–125

vasculopathy of. SeeVasculopathy, decidual

vernix caseosa in, 229Decidualization, 114

tubal pregnancy absence of,198–199

Deciduitisacute, 56, 64and chorioamnionitis, 280, 281,

285chronic, 56, 64in herpes simplex virus infection,

302in syphilis, 298, 299in systemic lupus erythematosis,

347Dehydration, fetal, 19Dermatomyositis, maternal, 320,

329Diabetes insipidus, maternal, 330Diabetes mellitus, maternal,

324–326, 330in abortion, 177effect on fetal nucleated red

blood cells, 381fibrinoid deposition, 118

Diandry, 184Diffusa, placenta. See

Membranacea, placenta.Dilatation and curettage (D&C), 12,

174Diploidy, 186, 188Discoid lupus, 346Diseases, maternal, 319-331.

connective tissue diseases, 320,329

diabetes mellitus, 324–326endocrine disorders, 177, 180,

330heart disease, 321, 329hematologic disorders, 322–324,

329liver disease, 321, 329renal disease, 320, 329thyroid disease, 324, 330, 424

Disomy, uniparental, 187, 188Disseminated intravascular

coagulation, abortion-associated, 174

DNA fingerprinting, 419DNA hybridization, 468–469DNA methylation, 188DNA polymorphisms, short

tandem repeat-derived, 419DNA testing, chorionic villous

sampling for, 185Doppler studies, in terminal villus

deficiency, 344–345Drug abuse, maternal, 327–328,

330

Drugs. See also names of specificdrugs

placental effects of, 328as spontaneous abortion cause,

177Dygyny, 184Dynamic placentation, 219–220Dysplasia

mesenchymal, 34, 40, 62, 368–370skeletal, 19

EECHO virus infection, 315Eclampsia, 333. See also

Preeclampsiahydatidiform mole-associated,

424pulmonary embolization of

syncytial cells in, 345–346Ectopia cordis, 244Edema

amnion, meconium-associated,234

in preeclampsia, 332–333pulmonary, in hydatidiform

mole, 424of umbilical cord, 36, 56, 258,

326, 407uterine, atony-associated, 191,

192villous, 181, 294, 372, 373, 407,

409, 474Ehlers-Danos syndrome, 320, 329Ehrlichiosis, 314Electron microscopy

of fetal metabolic storagediseases, 382

of fetal tissue, 20placental, 327

Electrophoresis, of hemoglobin, 376Embolism. See also Thrombosis

pulmonaryin induced abortion, 174in postpartum endometritis,

196of syncytial cells, 345–346

Embryoanomalies of, 3–6, 16–22, 181–185complete hydatidiform mole,

422–424, 480development of, 69–71examination of, 3–6, 16–22,

173–180macerated, 8weight of, 42

Embryoblast, 69, 70Embryonic disk, 77Embryonic pole, 71Embryonic remnants, 36, 227–228,

249–253

492 Index

Endocervicitis, maternal, 478Endocrine disorders, maternal, 330

as spontaneous abortion cause,177, 180

Endometrial glands, 10, 12, 114, 115

cytomegalovirus infection in, 301

postpartum changes in, 193Endometritis

herpetic, 302postpartum, 196–197syncytial, 447, 450

Endothelium, fetalcytomegalovirus inclusions in,

301development of, 73–74, 87as placental barrier component,

73preeclampsia-associated diffuse

injury to, 346vasculosyncytial membrane, 81–84

Endovasculitis, hemorrhagic (HEV),62, 64, 398, 399, 400, 401

active form of, 470–471bland form of, 398, 399, 470

Enterobius vermicularis infection, 317Enzyme studies, of fetal metabolic

storage diseases, 382Epignathus, 168–169Epithelium

alveolar, meconium-associateddamage to, 238

amnionic, 49–50, 52, 74, 88, 89,92, 122, 123

in cysts, 224, 233embryonic rests underneath,

227epithelial abnormalities of, 52gastroschisis-associated

vacuolation of, 239in glycogen storage disease

type IV, 385keratinization of, 240meconium-associated

degeneration of, 235squamous metaplasia of,

274–275in subacute chorioamniontis,

288Epitheloid trophoblastic tumors,

447, 456, 459, 460Epstein-Barr virus infection, 315Erythema migrans, 315Erythroblastosis fetalis (immune

hydrops fetalis), 351–352,371–375

clinical features of, 375pathogenesis of, 371–372pathologic features of, 372–375

Escherichia coli infection, 288, 292,293

Estriol, unconjugatedin chromosomal anomalies, 187measurement of, 186

Ethylenediaminetetraacetic acid(EDTA), 477

Exaggerated placental site, 447,450–451

Exencephaly, 244Exocoelmic cavity, 121–122Extravillous trophoblast, 50–51,

107–114of cell column, 133–134of cell island, 49, 131, 132–133of chorionic plate, 122, 124components of, 416in decidua basalis, 127development of, 72, 110–113, 122,

416–417differentiated from decidual

cells, 174–175, 201endothelial phenotype, 112–113endovascular phenotype, 111,

112-113function of, 72homogeneity of, 110immunohistochemical markers

for, 54–55interstitial (endovascular)

phenotype, 111, 112–113intraarterial phenotype,

112–113intramural phenotype, 112–113invasive phenotype, 110–111,

112lesions of, 447–461

differential diagnosis of, 456–459

epitheloid trophoblastictumors, 456

exaggerated placental site, 447,450–451, 456

extrauterine, 459–460placental site nodules, 447,

448–450, 456placental site trophoblastic

tumors, 447, 451–459migratory phenotype, 111–112multinucleated, 113, 114nuclei of, 109of the placental septa, 129, 131placental site giant cells, 108, 111,

113, 114, 115, 126in placental site subinvolution,

195proliferating phenotype, 110, 112properties of, 113–114pseudovasculogenesis of,

112–113

FFactor VII deficiency, 329Factor V Leiden mutation, 348, 401Fallopian tube

hydatidiform mole of, 426placental site trophoblastic tumor

of, 451Fatty liver of pregnancy, 231, 329Fetal alcohol syndrome, 327Fetal demise

in antiphospholipid antibodysyndrome, 348

chorangioma associated, 410chorangiosis associated, 360in chorionic villus sampling,

185–186in circumvallate placenta, 214fetal circulation in, 397in fetal thrombotic vasculopathy,

401in fetomaternal hemorrhage,

379in group B streptococcal

infection, 289as hemolysis cause, 275infection associated, 295, 311,

314, 316in maternal death, 355in maternal floor infarction, 366in maternal hypothyroidism,

324in maternal pheochromocytoma,

326meconium discharge and, 469placental changes in, 385–388placental infarction in, 338placental retention after, 206–207in preeclampsia, 333in scleroderma, 320in sickle cell anemia, 322smoking associated, 327and subchorionic hematoma, 232timing of, 474and trauma, 355in twins, 149–151, 166–167, 467,

468, 477–478umbilical cord associated, 247,

258–259, 262in villitis of unknown etiology,

469Fetal distress

and coiled umbilical cord, 253meconium discharge in, 238

Fetal growth restriction. Seeintrauterine growthrestriction (IUGR)

Fetal membranes. See Membranes,fetal

Fetal/placental weight ratio, 43,333

Index 493

Fetal reduction, in multiplepregnancies, 142

Fetal surface, of placenta, 31fibrin/fibronoid deposits on, 29macroscopic appearance of, 28,

29, 31macroscopic lesions of, 34–35microscopic lesions of, 58–59routine tissue sections of, 32

Fetal tissuecryopreservation of, 7, 19separation from nonfetal tissue,

16–17a-Fetoprotein. See Alpha-

fetoproteinFetomaternal hemorrhage. See

Hemorrhage, fetomaternalFetus

candidiasis of, 296–297karyotype of, 368macerated or disrupted, 17,

18–19, 21–22, 153, 154malpresentation of

effect on umbilical cord length,256

in placenta previa, 220and umbilical cord

entanglement, 253movement of

effect on umbilical cord length,256

as hemorrhage cause, 377sex determination in, 18, 21size of, correlation with

gestational age, 21thrombotic vasculopathy in. See

Thrombosis, in the fetalcirculation

weight of, 42in fetal/placental weight ratio,

43, 333Fetus papyraceous (compressus),

34, 56, 58, 153–155differentiated from vernix

caseosa, 228, 229Fibrin, 117–118

in basal plate, 64, 116, 117, 120in blood vessel intima, 398, 399,

401calcium deposits in, 120in circumvallate placenta,

211–212, 213, 214composition of, 49distribution of, 117–118in intervillous thrombi, 353matrix-type, See Fibrinoidperivillous, 361

massive deposition of, 363in placental septa, 129, 131subchorionic, 34

laminated, 361maternal smoking-associated

increase in, 327in thrombi, 232

in trophoblastic invasion, 119Fibrinoid, 107, 116–118

calcium deposits in, 120as cell island component, 49, 131,

132composition of, 48definition of, 116in dermatomyositis, 320distribution of, 48–49, 116–117extravillous trophoblast, 175fibrin-type. See Fibrinfunctions of, 118intervillous, See Fibrionoid,

periviloousintravillous, 101, 118definition of, 48Langhans’, 48, 122, 123, 124massive perivillous deposition,

363in maternal floor infarction, 362,

363–367, 480matrix-type, 117Nitabuch’s, 48–49, 70, 125, 126,

127–128perivillous, 47, 361–363

definition of, 48in maternal floor infarction

(MFI), 362, 363–367normal, 363–364

of placental septa, 129, 131preeclampsia associated necrosis

of, 333–334Rohr’s, 48–49, 70, 125, 126–127in scleroderma, 320of stem villi, 101subchorionic, 31, 34, 58

laminated, 361in trophoblastic invasion, 119uteroplacental. See Fibrinoid,

Nitabuch’sFibroangiomyxoma, 405Fibroblast

of amnionic mesoderm, 88of chorionic mesoderm, 90mosaicism of, 168of villous stroma, 85–86

Fibroma, 405Fibromuscular sclerosis, 385, 387,

398Flow cytometry, 7, 63

in fetomaternal hemorrhage, 380

for ploidy analysis, 186, 419Fluorescence in situ hybridization

(FISH), 186Foam cells, 329, 382

Folate/folic acid deficiency, 329,355

Follicle-stimulating hormone(FSH), in polyovulation, 140,141

Foot length, fetal, 21, 42correlation with gestational age,

18Formalin fixation, of placentas, 25,

32“Formalin pigment”, 33Fungal infection, 314, 315. See also

CandidiasisFunisitis, 274

acute, 56, 468in herpes simplex virus infection,

302in listeriosis, 292necrotizing, 56, 284, 286

in syphilis, 298, 300Furcate insertion of umbilical cord.

See Umbilical cord, insertionpatterns

Fusobacterium infection, 282, 288,293

GGalactosialidosis, 390Gangliosidosis type II (Sandhoff’s

disease), 384Gangliosidosis type I (Tay-Sach’s

disease), 383–384Gardnerella infection, 314Gastroschisis, 56, 239Gaucher’s disease, 329, 384Genetic disorders. See

Chromosomal anomalies;Congenital anomalies

Gestational age. See Age,gestational

Gestational hypertension. SeeHypertension, gestational.

Gestational trophoblastic disease

choriocarcinoma, 377, 436–446diagnosis of, 5–6, 436exaggerated placental site, 447,

450–455hydatidiform mole, 416–435

complete, 417–419, 420–425early, 424–425, 430invasive, 432–434partial, 418, 419, 426–428,

479–480persistent, 424, 426

placental site nodule, 445–450,457–458

placental site trophoblastictumor, 447, 451–459

staging of, 436–437, 438

494 Index

Gestational trophoblastic disease(cont.)

World Health Organizationclassification of, 417

Giant cellsplacental site, 125trophoblastic, 70, 126, 181, 184

Glossary, 484–485Glycogen storage disease type II,

384–385, 390Glycogen storage disease type IV,

385, 390Gonadotropin-releasing hormone

(GnRH), in polyovulation,141

Gonads, fetal, examination of, 18Gonorrhea, 314Gordon’s syndrome, 329Gram stain, 53–54, 55, 61, 63Granulocytes, decidual, 114–115Granuloma, tuberculous, 305Granulomatosis infantiseptica, 290Graves’ disease, 324Green coloration, of placenta, 234,

236, 469–470Ground-glass inclusion bodies, 302,

304Growth retardation. See Intrauterine

growth restrictionGrowth restriction. See Intrauterine

growth restriction.

HHaemophilus influenzae infection, 314Hair, in the amnionic fluid. See

Vernix caseosahCG. See Human chorionic

gonadotropinHead circumference, fetal, 18Hearing loss, congenital

cytomegalovirus infection-associated, 300

Heart block, congenital, 347Heart disease. See Cardiac

disorders/diseasesHELLP syndrome, 321, 333Hemangioblastic cells, 87Hemangioma

neonatal, 405–406of umbilical cord, 36, 271–272

as hydrops fetalis cause, 377medicolegal implications of, 471

Hematocrit, fetal, 471–472Hematoidin, 237Hematologic disorders, maternal,

322–324, 329Hematoma

marginal, 31in circumvallate placenta, 214

retromembranous, 54, 230, 231

retroplacental, 31, 34, 38, 64, 340,341, 342, 355–357, 377, 472

hemosiderin depositsassociated with, 470

subamnionic, 31, 34, 58, 229, 231subchorionic, 31, 34, 58

clinical features of, 232–233differentiated from Breus’

mole, 232–233as fetomaternal hemorrhage

cause, 378pathologic features of, 232tuberous. See Breus’ mole

umbilical cord, 36, 229, 231,272–273, 274

medicolegal aspects of, 471Hemoglobin, 375

fetalabnormal structure of, 375–376effect on villous tissue, 32, 471

Hemoglobin-H disease, 376Hemolysis

in acute fatty liver of pregnancy,321

in fetal demise, 275, 385of fetal membranes, 34hemosiderin deposits associated

with, 470as umbilical cord discoloration

cause, 36Hemolytic disease of the newborn,

317–375Hemorrhage

in chorioamnionitis, 282–283in choriocarcinoma, 377, 438, 440,

441, 444in circumvallate placenta, 214in dermatomyositis, 320fetal

in erythroblastosis fetalis, 372as hydrops fetalis cause,

376–377villous tissue in, 40of fetal surface, 34fetomaternal, 378–381clinical features of, 379–380as fetal anemia cause, 466as hydrops fetalis cause, 371as intervillous thrombi cause,

351, 353as intrauterine fetal demise

cause, 66pathogenesis of, 378pathologic features of, 378–379placental pallor associated,

471–472prenatal diagnosis of, 378

intravillous, 62, 354intervillous, See Intervillous,

thrombus

Kline’s, 351marginal, 38, 39in placenta previa, 220–221postpartum, 190–191

delayed, 192, 195, 204in maternal hypothyroidism, 324in placenta accreta, 190, 197–204in placental site subinvolution,

190, 192–196in placenta polyp, 190, 204–205in placenta previa, 220retained placental tissue-

associated, 190, 192uterine atony-associated, 190,

191–192transplacental

in chorangioma, 410cordocentesis-associated,

376–377umbilical cord, 36, 259, 272–274, 275

rupture, 274velamentous insertion, 266, 267

Hemorrhagic endovasculitis (HEV),62, 64, 398, 399, 400, 401

active form of, 470–471bland form of, 398, 399, 470

Hemorrhagic hereditarytelangiectasia, 329

Hemosiderin, 34, 54, 236–237, 238,470

avascular villi-associated, 397in circumvallate placenta, 214,

216in cytomegalovorus infection,

301in erythroblastosis fetalis, 372in extramembranous

(extrachorial) pregnancy, 216

in parvovirus B19 infection, 304in retroplacental hematoma, 356in umbilical cord discoloration,

36Hepatitis, 316Hepatoblastoma, congenital, 413Hepatocellular adenoma, 411Hepatosplenomegaly, in hydrops

fetalis, 375Hermaphroditism, true, 168Heroin abuse, 330Herpes simplex virus infection,

177, 302–303Herpesvirus infection, 469Heterotopia, 411High altitude

chorangioma associated, 406in hematologic disease, 329placental cyst in, 224placental effects of, 323

HLA antibodies, maternal, 324

Index 495

Hofbauer cells, 48, 86–87erythroblastosis fetalis-

associated, 372, 375granularity of, 383of immature intermediate villi,

99–100melanin deposits in, 121of mesenchymal villi, 99sacrococcygeal teratoma-

associated, 169storage diseases-associated,

382–383, 384in toxoplasmosis, 307vacuolization of, 382–383, 384

Human chorionic gonadotropin(hCG)

in choriocarcinoma, 436in chromosomal anomalies, 187in extrauterine extravillous

trophoblastic lesions, 460in gestational trophoblastic

disease, 437in hydatidiform mole, 423, 424,

427–428in hydrops fetalis, 375measurement of, 186in placental site trophoblastic

tumor, 456in sacrococcygeal teratoma, 414syncytiotrophoblast, 54in trophoblastic lesions,

457–458Human immunodeficiency virus

(HIV) infection, 316Human placental lactogen, 54, 375,

457–458Hurler’s disease, 390Hyaline membrane disease, 478Hydatidiform mole, 416–435

as choriocarcinoma risk factor,436, 437

complete, 417–419, 420–425biparental, 425differentiated from partial

hydatidiform mole, 428–432,480

early, 424–425embryonic and fetal tissue in,

422–424definition of, 417early, differentiated from

hydropic abortus, 430in ectopic locations, 426flow cytometric analysis of, 196hydropic villi associated with, 7as intervillous thrombi cause,

351–352invasive, 432–434partial, 418, 419, 426–428,

479–480

differentiated from completehydatidiform mole, 428–432,480

differentiated from hydropicabortus, 429

differentiated from mesenchymal dysplasia,368–369

triploidy, 188p57 analysis of, 432ploidy analysis of, 431–432trophoblastic proliferation in, 62villous tissue in, 40

Hydramniosin chorangioma, 410in hyperthyroidism, 324in twin-to-twin transfusion

syndrome, 477Hydrops fetalis, 371–378

in acardiac twins, 158in chorangioma, 410in chorioamnionitis, 312in cytomegalovirus infection, 300definition of, 371in hyperthyroidism, 324idiopathic, 378immune (erythroblastosis fetalis),

371–375clinical features of, 375as intervillous thrombi cause,

351–352pathogenesis of, 371–372pathologic features of, 372–375

nonimmune, 371etiology of, 389in metabolic storage disease, 382in parvovirus B19 infection,

303–304in toxoplasmosis, 306in trauma, 371, 376–377

nucleated red blood cells in, 372,381

placental, 40, 372villous tissue in, 40

Hyperbilirubinemiamaternal, 236, 321in twin-to-twin transfusion

syndrome, 166Hypercholesterolemia, 326Hyperemesis gravidarum, in

hydatidiform mole, 424Hyperglycemia, maternal, 324–325Hyperhomocysteinemia, maternal,

348Hyperlipidemia, maternal, 329Hyperreactio luteinalis, 423–424Hypertension, during pregnancy,

32–333. See also Eclampsia;Preeclampsia

associated with Breus’ mole, 233

in chorioamnionitis, 312etiology of, 479gestational, 332–333and hydatidiform mole, 424mesenchymal dysplasia

associated with, 368Hyperthyroidism, maternal, 324,

330, 424Hypervolemia, fetal, 324–325Hypoabetalipoproteinemia,

maternal, 326Hypoglycemia, in twin-to-twin

transfusion syndrome-, 166Hypoplasia, pulmonary, 241Hypothyroidism, maternal, 324,

330Hypoxia

fetal/prenatal, 359–360effect on brain development,

466, 471meconium discharge in, 238medicolegal implications of, 466nucleated red blood cells in, 381

high altitude-associated, 323postplacental, 342, 343, 344preplacental, 342, 343–344uteroplacental, 342villous maldevelopment

associated with, 342–344

II-cell disease (mucolipidoses type

II), 383, 384, 390Immunohistochemistry, 53–55, 57

in chronic villitis, 468–469tissue sample preparation for, 33of trophoblastic lesions, 457–458

Impetigo herpetiformis, 329Implantation pole, 71

orientation with yolk sac, 77Implantation site, of placenta

blastocyst competition for, 476histologic documentation of, 12, 13identification of, 174–175in spontaneous abortion

specimens, 14Implantation window, 71Imprinting, 187, 188, 419, 479, 480Inborn errors of metabolism. See

Metabolic disorders, fetalInclusion body blennorhoeae, 295Infarction

cerebral, fetomaternalhemorrhage-associated, 379

in chorangioma, 410differentiated from avascular

villi, 396of the maternal floor. See

Maternal floor infarctionplacental, 31, 32, 40, 60

496 Index

Infarction (cont.)in lupus anticoagulant, 348medicolegal aspects of, 472–473multiple, 472in placental malperfusion,

337–340, 341, 347, 348, 349in preeclampsia, 333, 337–340, 341in systemic lupus erythematosis,

347in thrombophilia, 349

Infectious disease, 279–318ascending infection, 279–297, 314

acute chorioamnionitis,280–288, 312–313

bacterial infections, 288–296associated with cerebral palsy,

468listeriosis, 290–292marginal hemorrhage

associated, 38as spontaneous abortion cause,

177streptococcal infections,

289–290intervillositis, 313villitis, 297–311, 315–317

Inflammatory mediators, role inlabor initiation, 281

Influenza, 316a-Inhibin, 54, 187, 457–458Inner cell mass, 69Intercotyledonary septa. See

Placental septaInterleukins, 281Intermediate layer. See Spongy

layerInterpositional insertion of

umbilical cord. See Umbilicalcord, insertion patterns

Intervillositis. See also Villitischronic, 60, 180, 313

Intervillous space, 8, 9, 32, 40, 60, 75abscess of, 40, 60, 291–292anatomy of, 105–106collapse of, 60, 339, 341definition of, 8development of, 72expansion of, 60during fetal membrane

development, 75fibrin and fibrinoid content of,

60, 116, 117first-trimester, 8, 9inflammation in, intervillositis,

313malignant cells in, 412microscopic lesions of, 60-61obliteration of, 74sickle cells in, 322–323thrombosis of, 31, 60, 348, 349,

351–353

Intimal fibrin/vascular cushions,398, 399, 401

Intracytoplasmic sperm injection(ICSI), 476

Intrauterine growth restriction(IUGR)

in acute chorioamnionitis, 312in antiphospholipid antibodies,

348and chorangioma, 410and chorangiomatosis, 361and chromosomal anomalies-,

181in circumvallate placenta-, 214and cocaine use, 327–328fetal thrombotic vasculopathy

associated with, 401and fetomaternal hemorrhage-, 66and furcate umbilical cord

insertion, 268in lupus erythematosis, 346in maternal floor infarction, 366in maternal hypothyroidism, 324and mesenchymal dysplasia, 368in multiple pregnancy-, 476in preeclampsia, 333in sickle cell anemia, 322and subchorionic hematoma, 232and terminal villus deficiency,

344in thalassemia, 323thrombosis associated, 470in twins, 141–142in twin-to-twin transfusion

syndrome, 166and the umbilical cord

coiled umbilical cord, 253excessively long umbilical

cord, 256–257excessively thin umbilical cord,

257and villitis of unknownetiology, 309, 311, 469

Intravillous hemorrhage, 62, 354In vitro fertilization, twinning rate

in, 141Involution of the placental site,

192–193, 194, 206–207Iron stain, 55, 57, 59Ischemia, villous, 60Islands. See Cell islandsIUGR. See Intrauterine growth

restriction

JJunctional zone, 70, 128

KKaryorrhexis

in fetal demise, 385, 386in hemorrhagic endovasculitis,

398

intravascular, 385, 386and placental infarction, 339, 340

Karyotypefetal, 368of hydatidiform mole, 418–419

Keratinizationof the amnionic epithelium, 240of subamnionic epithelium cysts,

224Kleihauer-Betke stain, 61, 63,

379–380, 381, 471, 478Knots

syncytial, 47, 60, 83, 84, 341, 474as artifacts, 341in avascular villi, 396in fetal death, 387in perfusional compromise,

341–342in preplacental hypoxia,

343–344in retained placenta, 206in sickle cell anemia, 323Tenney-Parker changes as,

343–344in terminal villi, 48, 341–342in trisomies, 181, 183

of umbilical cord, 36, 260–262,263, 471

examination of, 28false, 261–262, 273true, 260–261, 262, 263, 471in twins, 149–151

LLabor

prematurein acute chorioamnionitis, 280,

478, 479tumultuous, in fetomaternal

hemorrhage, 378Lacunar stage, of placental

development, 71–73Lacunar system, 70, 71, 72Langhans’ cells (villous

cytotrophoblast), 11, 80, 85,99–100, 110

Langhans’ fibrinoid, 48, 122, 123, 124Laser therapy, for twin-to-twin

transfusion syndrome, 166,477

Legal issues, role of placentalfindings in, 24, 465–475

Leiomyoma, 410–411In multilobed placenta, 209–210In placenta accreta, 199submucosal, in spontaneous

abortion, 177Leishmania major infection, 317Leprosy, 305Leptospira infection, 315Leukemia, 412, 413, 414, 415

Index 497

Limb abnormalities, fetal, 18–19, 20Limb-body wall complex, 243, 244,

245Lipofuscin, 121Listeria infection/listeriosis, 177,

282, 288, 290–292Lithium carbonate solution, 33Lithopedion, 154Litigation. See Legal issuesLiver

heterotopic, 411metastases to, 439, 442, 443, 454

Liver disease, maternal, 321, 329Lobes, placental. See CotyledonsLochia, 193Low birth weight

in malaria-, 307in sickle cell anemia, 322and smoking, 327

Lupus anticoagulant, 333, 347–348,470, 472–473

Lupus erythematosus. See Systemiclupus erythematosus

Luteal phase defects, 177Luteinizing hormone (LH), in

polyovulation, 141Lyme disease, 315Lymphocytes, fetomaternal transfer

of, 382, 478Lymphocytotoxic antibodies, 346Lymphogranuloma venereum,

295Lymphoma, 412, 413Lyonization, 168Lysergic acid diethylamide (LSD),

330

MMacrophages

cholesterol-containing, 335of chorionic mesoderm, 90decidual, 114–115meconium-containing, 92, 234,

235, 236, 238melanin-containing, 121of umbilical cord, 92villous. See Hofbauer cells

Macroscopic examinationof first-trimester products of

conception, 3–7indications for, 33of second-trimester products of

conception, 16–22of third trimester the placenta,

23–43Macrosomia, 324, 368Magma reticulare, 77Malaria, 307–308Malperfusion, placental, 332–350,

333–350In preeclampsia, 333–346

in systemic lupus erythematosus,346–348

In thrombophilia, 348–349Malpractice litigation, See Legal

issues.Marginal insertion of umbilical

cord. See Umbilical cord,insertion patterns.

Marginal sinus, 129Marginal zone, 107, 128–129

fibrinoid deposition in, 361–362Marijuana abuse, 330Mast cells, 86, 92Maternal diseases. See Diseases,

maternalMaternal floor infarction (MFI), 38,

60, 64, 362, 363–367, 480medicolegal aspects of, 472as recurrent/habitual abortion

cause, 180Maternal surface, of the placenta

macroscopic lesions of, 38–39microscopic lesions, 64–65routine tissue sections of, 32of the term placenta, 30

Meckel’s diverticulum, 252Meconium, 56, 233–239, 274, 275

chemical composition of, 233–234clinical features of, 238definition of, 233fetal aspiration of, 238, 470macrophages in, 54, 58medicolegal aspects of, 238,

469–470pathogenesis of, 238pathologic features of, 234–238as umbilical cord discoloration

cause, 36vasoconstrictive effects of,

469–470Meconium aspiration syndrome,

238, 470Medulloblastoma, 412Melanin, 121Mel-CAM, 54, 457–458Membranacea, placenta, 218–219Membranes, fetal, 5, 6, 49–51, 52,

88–92. See also Amnion;Chorion laeve

abnormalities of, 223–248in acute chorioamnionitis, 34color of, 27, 31, 34composition of, 49–50definition of, 49development of, 74, 76–77edema of, meconium-associated,

234examination protocol for, 27–28function of, 88hemosiderin content of, 34insertion site of, 27

macroscopic examination of, 31macroscopic lesions of, 34, 35microscopic examination of,

49–51microcopic lesions, 54–57meconium staining of, 34normal, 50pathology of, 223–248premature rupture of

amnion nodosum associatedwith, 240

in circumvallate placenta, 214in Ehlers-Danos syndrome, 320

routine tissue sections of, 32rupture of, in acute

chorioamnionitis, 280–821rupture site measurement of, 27second-trimester, 16teratomas of, 226tumors of, 226

Meningitis, 290–291, 293, 314Meningocele, 2446-Mercaptopurine, 328Mesenchymal cells, 85, 86

immunohistochemical markersfor, 55

Mesenchymal dysplasia, 34, 40, 62,368–370

Mesenchymeembryonic, 72extraembryonic, 77, 121–122

Mesoblast, extraembryonic, 92Mesoderm

amnionic, 49–50, 77, 88, 122, 123chorionic, 77, 90–91, 122, 123, 124extraembryonic, 70

Metabolic disorders, fetal, 20, 60,382–385, 390

Metastatisto the placenta

breast carcinoma, 412cervical carcinoma, 412melanoma, 412, 413pancreas, 412pseudometastasis, 412pulmonary adenocarcinoma,

412skin, 412

gestational trophoblastic diseaseto aorta, 442to bone marrow, 454to brain, 439, 442, 454to cervix, 439, 442to coronary artery, 442to eye, 442to gastrocnemius muscle, 442to gingiva, 442to intestines, 439, 442to kidney, 439, 442to liver, 439, 442, 443, 454to lung, 439, 442, 454

498 Index

Metastatis (cont.)to ovary, 439, 442, 454to pancreas, 454to pelvis, 439, 442, 454to spleen, 439, 442, 454to subungual region, 442to urinary bladder, 454to vagina, 439, 454

Methotrexate, 328MIB-1 antibody, 55Microcalcification, villous, 120–121Microcephaly, 366, 379Microscopic examination

of first-trimester products ofconception, 8–14

of placental membranes, 49–51,52

of second and third trimesterplacenta, 45–66

approach to specimen in, 52–55sections taken, 21–22, 53–54

of umbilical cord, 51–52Mineralization, placental, 120–121Miscarriage. See Abortion,

spontaneousMolecular testing, of fetal tissue, 7Monosomy X (Turner’s syndrome),

184, 185, 233Morquoi’s disease, 390Mortality,

Fetal, See Fetal demisematernal

in pheochromocytoma, 326in placenta accreta, 198in preeclampsia, 333

Mosaicism, 168, 185, 187chromosome analysis of, 33, 168confined placental, 7, 187–188,

480Motilin, 238Mucolipidosis type I, 390Mucolipidosis type II (I-cell

disease), 383, 384, 390Mucopolysaccharides, as

meconium components,233–234

Mucopolysaccharidoses, 390Multilobation, placenta, 208–211Multiple gestation, 135–169. See

also TwinsMumps, 316Mycobacterial infection, 305Mycoplasma infection, 294–295Myocarditis, in parvovirus B19

infection, 304Myofibroblasts, 86, 92Myometrium, 70

adherent, 64invasion in placental site

trophoblastic tumors of, 451

in invasive hydatidiform mole,433

meconium-stained macrophagesin, 236

in placenta accreta, 197–198, 199,200–201

in uterine atony, 191, 192vernix caseosa in, 229

Myositis ossificans, 329MZ. See Twins, monozygotic

NNatural killer cells, endometrial,

114–115Necrosis

of amnion, 302, 303amputation-associated, 401in choriocarcinoma, 438, 441of chorionin herpes simplex virus infection,

303decidual, 34, 38, 64, 175, 335, 336fibrinoid, 333–334in funisitis, 284, 286in placental site involution, 194subamnionic, 320villous, 291–292

Neisseria gonorrhoeae, 314Neonatal

anemia, 379autopsy, 478candidiasis, 295–296cytomegalovirus infection, 300prematurity in bacterial

infection, 288stroke, 348, 402thrombocytopenia, 324thrombosis, 401–402

Neoplasms, placental, 405–415fetal neoplasms, 405, 413–415maternal neoplasms, 412–413primary placental, 405–413

Nephropathy, diabetic, 326Neural tube defects, 187Neuroblastoma, congenital, 413,

414Neuronal ceroid lipofuscinosis, 390Nevi, fetal giant pigmented, 414Newborns. See NeonatalNiemann-Pick disease, 329, 390

type A, 384Normative values, 42–43NRBCs. See Nucleated red blood

cellsNuchal cord. See Umbilical cord,

nuchal. 378 Nucleated red blood cells, 64, 381

in chorangioma, 406in hydrops fetalis, 372, 381medicolegal aspects of, 473

OOligohydramnios

and amnion nodosum, 240, 241in chronic chorioamnionitis, 312in extramembranous

(extrachorial) pregnancy, 216prolonged, fetal sequelae of, 241in single umbilical artery, 269in twin-to-twin transfusion

syndrome, 163–164Oligosaccharidoses, 390Omphalomesenteric duct

development of, 77, 250remnants of, 250–252

Omphalomesenteric vessels, 77, 79yolk sac remnant-associated, 227

Ophthalmia neonatorum, 295, 314Ovary

cysts of, 375, 423hydatidiform mole of, 426

PParvovirus B19 infection, 303–305Paternity diagnosis, 186Peptostreptococcus infection, 288Periarteritis nodosa, 329Perilobular zone, 106Periodic acid-Schiff (PAS)-positive

lysosomal inclusions, 384Perivascular contractile sheath, 86,

102Perivascular rings, in necrotizing

funisitis, 286p57, 432Phenylketonuria, 329Pheochromocytoma, 326–327, 355Physiologic conversion of decidual

vessels, 119–120absence of

in abortion, 14, 175in preeclampsia, 333–334

normal, 334Pigments, placental, 33, 120–121.

See also Bile; Bilirubin;Hemosiderin; Meconium

in malaria, 307, 308Placenta

abruptio. See Abruptio placentaaccreta, 64, 193, 197, 221, 480

focal, 199, 204–205overdiagnosis of, 203–204tubal, 198–199underdiagnosis of, 200–201, 203

bilobed, 30, 40, 208–210circummarginate, 40, 212, 214circumvallate, 40, 129, 211–215,

236in extramembranous

(extrachorial) pregnancy, 216development of, 67–134

Index 499

early villous stage, 70, 73lacunar stage, 71–73post-second week, 74, 75prelacunar stage, 69–71

diameter/thickness of, 30–31normative values of, 43

diamnionic-dichorionic (DiDi),138, 139, 140, 142, 143–144,146–148

diamnionic-monochorionic(DiMo), 138, 139, 140, 142,143, 148, 158

examination of, 27, 28, 30extramembranous (extrachorial)

pregnancy, 40, 215–217fenestrata, 40, 219in fetal demise, 385–388hemochorial, 80–81increta, 197, 198involution of, in retained

placenta, 206–207macroscopic examination of,

23–43measurement of, 28membranacea (diffusa), 30, 40,

199, 218microscopic examination, 45–53monoamnionic-monochorionic

(MoMo), 130, 138, 139, 140,148–151, 158, 159, 161, 262,467

multilobed, 208–211normal, 23, 31–32pathologic examination of, 25–32

instruments for, 25procedure for, 27–30selection criteria for, 23–24serial sectioning of, 30worksheet for, 26

percreta, 197–198, 480–481previa, 219–221

in multiple pregnancy, 142in placenta accreta, 199

previa accreta, 221pseudomonoamnionic, 149retained, involution of, 206–207second-trimester, microscopic

evaluation of, 45–66shape abnormalities of, 30, 40–41,

208–222storage of, 25succenturiate lobes of, 30, 40,

210–211surface of, 29. See also Fetal

surface; Maternal surfacethird-trimester, microscopic

evaluation of, 45–66weighing of, 28, 30–31

formalin fixation-associatedincrease in, 25

normative values of, 43storage-associated loss of, 25

zonary (annular), 40, 219Placental alkaline phosphatase, as

trophoblastic lesion marker,457–458

Placental protein 5, as hydropsfetalis marker, 375

Placental protein 19, 54Placental septa, 47, 49, 107, 129–131

absence of, 129cysts of, 131, 132fibrin and fibrinoid content of,

116, 117, 120intercotyledonary, 129, 131in placental accreta, 200structure of, 11

Placental siteinvolution of, 192-193, 194subinvolution of, 192, 193, 195–196

Placental site nodule, 447, 448–450differential diagnosis of, 457–458

Placental site trophoblastic tumor,447, 451–459

clinical features of, 451clinical implications of, 454–456differential diagnosis of, 456–459metastatic, 454–456pathologic features of, 451–454

Placentationanimal models of, 479dynamic, 219–220

Placentones, 105–106, 392Plasma cells, 86, 347Plasmalemmas, syncytial, 82Plasmodium, 307Ploidy analysis, 63

for hydatidiform mole diagnosis,431–432

Poliomyelitis, 316Polycystic ovary syndrome, in

spontaneous abortion cause,177

Polyhydramniosin acardiac twins, 158in mesenchymal dysplasia, 368in multiple pregnancy, 142in single umbilical artery, 269in twin-to-twin transfusion

syndrome, 163–164, 165–166Polymerase chain reaction (PCR),

186, 419, 468–469Polyovulation, 140–141Polyp, placental, 204–205Pompe’s disease, 384–385, 390Potter’s sequence, 241Prednisone, 348Preeclampsia, 332–346

and abruptio placentae, 333, 340,355, 357

and acute fatty liver ofpregnancy, 321

and chorangioma, 410and chorangiomatosis, 361and chorangiosis, 359clinical features of, 333–346and cocaine use, 327–328diagnosis of, 332–334and fetal or maternal demise,

333and fetal thrombotic

vasculopathy, 401and fibrinoid deposition, 118and hydatidiform mole, 424in hypothyroidism, 324and intervillous thrombi, 351and mesenchymal dysplasia, 368in multiple pregnancy, 142pathogenesis of, 346and placental infarction, 337–340,

472–473and placental malperfusion,

333–346placental pathologic features in,

333–346pulmonary embolization of

syncytial cells in, 345–346in renal transplantation, 320in sickle cell anemia, 322

Pregnancydocumentation of, in therapeutic

abortions, 12ectopic, 198-199, 426extramembranous (extrachorial),

40, 215–217molar. See Hydatidiform molemultiple. See also Triplets; Twins

in assisted reproductivetechnology, 466

associated with chorangioma,405–406

complications of, 137fetal reduction in, 142, 162placental examination in,

142–146, 161–162and prematurity, 476in spontaneous abortion, 177

Pregnancy induced hypertension.See Preeclampsia andHypertension, gestational.

Prelacunar stage, of placentaldevelopment, 69–71

Prematurityin acute chorioamnionitis, 280in ascending infection, 468and chorangiomatosis, 361in circumvallate placenta, 214and cocaine use, 327–328in Ehlers-Danos syndrome, 320and fetal anomalies, 66

500 Index

Prematurity (cont.)in group B streptococcal

infection, 289malaria-associated, 307in maternal diabetes mellitus,

324in multiple pregnancy, 476medicolegal aspects of, 466in placenta membranacea, 218in twins, 141–142in Ureaplasma infection, 294

Premature labor. See PrematurityPrevia. See Placenta, previaProducts of conception

chromosomal anomalies in,181–187

first trimester, 3–15cryopreservation of specimens,

7cytogenetic analysis of, 6–7differentiated from

choriocarcinoma, 439exaggerated placental site in,

450flow cytometry analysis of, 7macroscopic examination of,

3–7microscopic examination of,

8–14microscopic sections of, 7pathology of, 170–180spontaneous abortion

specimens, 14therapeutic or induced

abortion specimens, 12–13second-trimester, 16–22

cytogenetic analysis of, 19diagnostic findings in, 21–22gross examination and

description of, 16–22microscopic sections of, 21–22radiographic documentation,

19, 20Protein C, activated resistance, 401Protein C deficiency, 348, 401Protein S deficiency, 348, 401Proteinuria, in preeclampsia,

332–333Prothrombin mutation, 348Pruritus gravidarum, 329Prussian blue stain, 237Pseudoinclusions, trophoblastic,

426Pseudometastases, 412Pseudopods, 449–450Purpura, thrombotic

thrombocytopenic, 323–324,329

Pyelonephritis, and allantoic ductremnants, 250

QQ fever, 314Quadruple (quad) test, 186

RRadiation exposure, during

pregnancy, 328Radiography, of fetal limb

abnormalities, 19, 20Relapsing fever, 315Renal disease, fetal

mesenchymal dysplasiaassociated with, 368

renal agenesis, amnion nodosum associated with,240, 242

renal vein, thrombosis of, 325Renal disease, maternal, 320, 329Restriction fragment length

polymorphism (RFLP), 419Rhabdomyosarcoma, 412Rheumatic heart disease, 321Rheumatoid arthritis, 329Rh (rhesus) incompatibility, 372,

375–376, 380Rickettsia infection, 314Rubella infection, 297, 316Rubeola infection, 316

SSacral agenesis, 326Saline injection, as abortion

method, 174, 175, 176Salla’s disease, 390Salmonella infection, 314Sandhoff’s disease, 384San Filippo’s disease, 390Sarcoidosis, 329Sarcoma, 413Schistosomes, 317Scleroderma, 320, 329Seizures

in eclampsia, 333fetal thrombotic vasculopathy

associated with, 401Separation zone, 128Sepsis, 286, 289-291, 193, 194, 195,

314Septostomy, as treatment for twin-

to-twin transfusionsyndrome, 166

Sex determination, of fetus, 18, 21Shape abnormalities, placental,

40–41, 208–222Shigella infection, 314Shock, neonatal, 355Sialic acid storage disease, 390Sialidosis, 390Sickle cell anemia/disease,

322–323, 329, 376

Sinusoids, 80, 103Sirenomelia, 240Skeletal dysplasia, 19Sly disease, 390Small-for-gestational age. See

Intrauterine growthrestriction

Small intestine, atresia of, 252Smallpox, 316Smith-Lemli-Opitz syndrome, 329Smoking, 180–181, 281, 327, 330Spirochetes, 297–298, 315Spongy layer, 50

chorionic, 86, 90, 122, 123, 124of the extraplacental membranes,

88Sprouts, syncytial, 58, 82, 84–85Sprouts, trophoblastic, 58, 73, 82,

84–85, 98, 184Squamous epithelial masses,

205–206Squamous metaplasia, 34, 56, 240,

274–275Stains

Gram, 53–54, 55, 61, 63Hematoxylin and eosin, 53 immunohistochemical, 53–55, 57Kleihauer-Betke, 61, 63, 379–380,

381, 471, 478Luna-Ishak (bile), 237Prussian Blue, 55, 57, 59, 237

Staphylococcal infection, 292, 314Stem cells

hematopoietic, development of, 87of the syncytium, 80trophoblastic, 108, 110

Stem vesselshistologic examination of, 53luminal abnormalities of, 385,

387thrombosis of, 397-399

Stem villi. See Villi, stemSterility, in Ureaplasma infection, 294Stillbirth, See Fetal demiseStorage, of placentas, 25Storage disorders, fetal, 60,

382–385, 390Streptococcal infection, 283, 288,

289–290, 314Stroke, neonatal, 348, 402Stroma

endometrial, 114, 115decidual, 114, 115in ovarian theca lutein cysts, 424trophoblastic invasion of, 124villous, 11, 53, 99, 100, 101, 102,

103, 104in avascular villi, 397cytomegalovirus inclusions in,

301

Index 501

fibrinoid content of, 118during first trimester, 11in herpes simplex virus

infection, 302of immature intermediate villi,

48of immature villi, 86microcalcification of, 387in villitis, 62

Subchorionic closing ring, 128–129Subchorionic space. See also

Hematoma, subchorionicfibrin and fibrinoid content of,

116, 117Subinvolution, of the placental site,

192, 193, 195–196Substance abuse, maternal,

180–181, 466Succenturiate lobe, 210–211Superfecundation, 160Superfetation, 160Supernumerary vessels, 270Surfactant therapy, 478Syncyntial bridges, 84–85Syncytial cells, pulmonary

embolization of, 345–346Syncytial knots, See Knots,

syncytialSyncytial sprouts, 73, 98, 184Syncytial endometritis, 447, 450Syncytiotrophoblast

of cell columns, 133in choriocarcinoma, 438in chorionic plate development,

121cytomegalovirus inclusions in,

301development of, 70, 71, 74, 110function of, 80, 81–82immunohistochemical markers

for, 54passage to maternal lung, 382as placental barrier component, 73structure of, 80, 81–85trabeculae of, 71, 72, 73vacuoles of, 71

Syphilis, 57, 286–287, 297–298, 299Systemic lupus erythematosus, 180,

346–348Systemic sclerosis, 320

TTakayasu’s arteritis, 329Tay Sachs disease, 383–384TEARS sequence, 243Tenney-Parker changes, 323,

343–344, 345, 347Teratoma

acardiac twinning, congenital, 413, 414

of the fetal membranes, 226relationship with acardiac

twinning, 157, 169, 226, 411sacrococcygeal, 168–169, 414of umbilical cord, 272

Terminal villus deficiency, 60,343–345, 474

Tetraploidy, 185a-Thalassemia, 375–376b-Thalassemia, 323, 329, 375, 376Thalassemia, abnormal red blood

cell structure in, 375Theca lutein cysts, 423Thiazide, 324Thrombocytopenia

in hydrops fetalis-, 375idiopathic, 323neonatal, 324

Thrombophilia, 33-324, 329, 333,348

and fetal vascular thrombosis,401

and intervillous thrombi, 351and placental infarction, 472–473and subchorionic hematoma, 232and vascular thrombosis, 401,

470Thrombosis

and antiphospholipid antibodies,348

and chorangioma, 410decidual, 340, 358

in preeclampsia, 333–334, 336in systemic lupus

erythematosus, 347in the fetal circulation (fetal

thrombotic vasculopathy),34, 325, 392–402

avascular villi associated with,396–397, 401

calcification of, 393, 394, 395,396

of chorionic vessels, 394, 395clinical features of, 401–402fibromuscular sclerosis, 399hemorrhagic endovasculitis,

398, 399, 400, 401hyaline, 324intimal fibrin/vascular

cushions, 398, 399, 401mural thrombi, 286, 287, 336,

392, 393, 394, 395pathogenesis of, 400–401pathologic features of, 392–400surface thrombi, 392–393

intervillous, 31, 40, 351–353in lupus anticoagulant, 348in erythroblastosis fetalis, 372in fetomaternal hemorrhage,

378

in idiopathicthrombocytopenia, 323

in thrombophilia, 349in maternal diabetes, 325subchorionic, laminated, 232of the umbilical cord, , 256, 257,

259, 270-271, 326–327,376–377, 392

of velamentous blood vessels,266

in villitis of unknown etiology,309

Thyroid disease, maternal, 324, 330,424

Thyroiditis, postpartum, 478Tissue sections, placental

for chromosomal analysis, 33fixation of, 32–33routine, 32

T lymphocytes, decidual, 114–115TOPS (twin oligohydramnios

polyhydramnios sequence).See Twin-to-twin transfusionsyndrome

TORCH infections, 66, 297Toxoplasmosis, 177, 305–307Trabeculae, of the syncytiotroblast,

71, 72, 73Trachoma, 295Transfusion syndrome, twin-to-

twin. See Twin-to-twintransfusion syndrome

TRAP (twin reversed arterialperfusion). See Twins,acardiac

Transplacental hemorrhage. SeeHemorrhage, fetomaternal

Transplacental passage of cellularelements, 382

Traumaand abruptio placenta, 355and fetal thrombotic

vasculopathy, 401and fetomaternal hemorrhage,

378and hydrops fetalis, 371,

376–377and spontaneous abortion, 177

Treponema pallidum, 297–298Trichomonas infection, 283Trichomonas vaginalis infection, 317Triple screen test, 186Triplets, 161–162

chorionicity of, 161congenital anomalies in, 141

Triploidy, 184, 185, 186, 419,431–432, 479

Trisomies, 181–184, 187, 479karyotype mosaicism with,

187–188

502 Index

Trophoblastcytokeratin staining of, 175definition of, 69development of, 69, 70, 416–417distribution of, 108of extraplacental membranes,

91extravillous. See Extravillous

trophoblastintermediate. See Extravillous

trophoblastintraarterial, 119migratory, 91necrotic residues of, 124–125role in pregnancy

documentation, 12structure and histology of, 88,

89transitional, 438vacuolization of, in fetal storage

disorders, 382villous, 110, 416–417

Trophoblastic implants, 459–460Trophoblastic invasion. See also

Extravillous trophoblastof the decidua, 124–125in placenta accreta, 197–198during placental development,

72in preeclampsia, 334of the uteroplacental arteries,

119–120Trophoblastic shell, 71, 72–73, 124,

125as chorion laeve component,

74Trophotropism, 210, 219–220, 266,

267Trypanosoma cruzi infection, 317TTTS. See Twin-to-twin transfusion

syndromeTuberculosis, 305Tumor cells, transplacental passage

of, 382Tumor necrosis factor, 281Tumors, 405–461Turner’s syndrome. See Monosomy

XTwin oligohydramnios

polyhydramnios sequence(TOPS). See Twin-to-twintransfusion syndrome

Twin peak sign, 144Twin reversed arterial perfusion

(TRAP). See Twins, acardiacTwins

acardiac, 138, 156–159amnion nodosum associated

with, 240clinical features of, 158

definition of, 156pathogenesis of, 156–157pathologic features of, 157–158relationship with teratomas,

157, 169, 226, 411acute chorioamnionitis in, 280cerebral palsy in, 167chimerism in, 167–168congenital anomalies in, 141conjoined, 138, 159–160

pathologic features of, 159–160,161

placentation of, 140diamnionic-dichorionic (DiDi),

138, 139, 140, 142, 143–144,146–148

diamnionic-monochorionic(DiMo), 138, 139, 140, 142,143, 148

vascular anastomoses in,145–146, 156, 163, 166, 467,468, 477

dizygotic (“fraternal”), 137–138etiology of, 140–141placentation of, 138, 139, 140,

477fetus papyraceous, 153–155heterokayrotypic, 168identical. See Twins, monozygoticincidence of, 138in utero death of, 149–151,

166–167, 467, 468, 477–478irregular chorionic fusion in, 146,

148medicolegal issues associated

with, 467–468monoamnionic-monochorionic

(MoMo), 138, 139, 140,148–151, 158, 159, 161, 262

central nervous system injuryin, 467

fetal demise in, 149–151, 468twin-to-twin transfusion

syndrome in, 165umbilical cord entanglement

of, 468monozygotic (“identical”), 137

etiology of, 141heterokaryotypic, 168placentation of, 138, 139, 140presenting as sacrococcygeal

teratomas, 168–169mosaicism in, 168pseudomonoamnionic, 149superfecundation, 160superfetation, 160third type of, 160, 167–168umbilical cord features of,

141–142, 149–151, 153–155,264

vanishing twin phenomenon,153–155

variants of, 160zygosity of, 137–138

Twin-to-twin transfusion syndrome(TTTS), 163–167, 477–478

acute, 166–167, 467–468acute-on-chronic, 468amnion nodosum associated

with, 240chronic, 163–166, 468medicolegal aspects of, 477treatment for, 477villous tissue in, 40

UUltrasound, prenatal, 375, 480, 481Umbilical artery, 51, 92

in funisitis, 286macroscopic examination of, 392maternal smoking-associated

damage to, 327meconium-associated damage to,

236necrosis of, 274single, 31, 36, 58, 92–93, 268–270

in circumvallate placenta, 214in conjoined twins, 159in limb-body wall complex,

244in maternal diabetes, 325–326in maternal drug use, 327in trisomy, 181in twin pregnancies, 141–142,

146velamentous umbilical cord

insertion associated with,264

Umbilical cord, 51–52, 53, 92–94,249–276

angioma of, 271–272calcification of, 36, 56candidiasis of, 36, 296, 297coiling of, 253–255color of, 31, 36, 275of conjoined twins, 159cysts of, 36, 224, 250, 251development of, 69, 71, 77–79diameter of, 16, 36

abnormalities of, 254–255,257–258, 273–274

discoloration of, 275edema of, 36, 56, 258, 326, 407embryonic remnants of, 249–253entanglement of, 258–260

in fetal demise, 247in umbilical cord hematoma,

272–273in monozygotic,

monochorionic twins, 468

Index 503

in second-trimester abortus, 16thrombi associated with, 470

fetal demise-associated changesin, 385, 386

hemangioma of, 36, 56, 271–272,377, 471

hematoma of, 36, 229, 231,272–273

medicolegal aspects of, 471hemorrhage of, 36, 272–274, 275insertion patterns of, 28, 263

abnormal, 141–142, 263–268in bilobed placenta, 208–209central, 28eccentric, 28, 31furcate, 31, 36, 263, 264, 265interpositional, 36, 263, 264,

265marginal, 28, 31, 36, 141, 263paracentral, 28in twin pregnancies, 141–142,

146velamentous, 28, 31, 36,

263–264, 471knots of, 28, 36, 260–262

false, 261–262, 273true, 256, 260–261, 262, 263,

471in twins, 149–151

length of, 16, 36abnormal, 255–257, 272–273, 274in Beckwith-Wiedemann

syndrome, 377excessively long, 36, 470, 471normative values of, 43second-trimester, 16

macroscopic examination of, 28macroscopic lesions of, 36–37microscopic lesions of, 56–58meconium staining of, 236medicolegal aspects of, 471miscellaneous lesions, 272–275nuchal, 258–259, 378prolapse of, 220, 258–260, 471routine tissue sections of, 32rupture of, 36, 274, 275, 471strictures of, 36, 253–255teratomas of, 56, 272thrombosis of, 273, 326–327torsion or twisting of, 28, 30, 31,

36, 253–255tumors, 271–272in twins, 141–142vasoconstriction or

vasodilatation of, 93–94Umbilical vein, 51, 92

atrophy of, 51in funisitis, 286maternal smoking-associated

damage to, 327

meconium-associated contractionof, 238

persistent, 31, 36, 270segmental thinning of, 274, 275thrombosis of, 261, 394

Umbilical vessels, 36, 92–94. Seealso Umbilical arteries;Umbilical veins

anatomy of, 392aneurysm of, 36, 58, 471compression of, 272of conjoined twins, 159microscopic examination of,

51–52, 53necrosis of, 274segmental thinning of, 274, 275supernumerary, 58, 270thrombosis in, 36, 259, 270–271,

376–377, 392Ureaplasma infection, 288, 294–295Urea injection, as abortion method,

174, 176Urethritis, nongonococcal, 295Urinary bladder

primary extraembryonic, 77Uteroplacental arteries, 12

anatomy of, 118–119fibrin and fibrinoid content of,

117trophoblastic invasion of, 108,

119–120Uteroplacental veins, 12

trophoblastic invasion of, 119Uteroplacental vessels, 118–120Uterus

atony of, 190, 191–192choriocarcinoma of, 440perforation of, 174, 433, 451postpartum, 193, 195rupture of, 193, 198

VVacuolization

of amnion, in gastroschisis, 239in choriocarcinoma, 438, 442in fetal storage disorders,

382–383, 384of syncytiotrophoblastic mass, 71

Vaginosis, bacterial, 295“Vanishing twin” phenomenon,

153–155Varicella, 317Vasa aberrantia, allantoic duct

remnants-associated, 250Vasa previa, 210, 267Vascular disease, maternal, 355,

357–358Vasculitis

chorionic, in herpes simplexvirus infection, 302

decidual, in preeclampsia,334–335

Vasculopathy. See also Atherosis,decidual

decidual, 56, 64, 333and abruptio placenta, 357–358and lupus anticoagulant, 348and preeclampsia, 333and systemic lupus

erythematosis, 347thrombosis, 324, 340

fetal thrombotic. See Thrombosis,in the fetal circulation

Vasculosyncytial membranes, 82, 83Vasoconstriction

placental, in maternal cocaineuse, 327–328

of umbilical cord, 93–94Velamentous cord insertion. See

Umbilical cord, insertionpatterns, velamentous

Vernix caseosa, 34, 56, 228–229, 230in amnion nodosum, 240–241differentiated from fetus

papyraceous, 228, 229meconium staining of, 236as cause of squamous epithelial

masses, 205, 206in uterine veins, 229

Villi, 5, 53, 80–85anchoring, 11, 47, 49, 73, 100, 103atrophied (“ghost”), 50avascular, 62, 396–397, 400, 470calcification of, 14, 62, 384characteristics of, 99congestion of, 59, 64, 358–360development of, 70, 73, 96–106

effect of hypoxia on, 342–344maldevelopment, 60, 341–344,

473–474relationship with hypoxia,

342–343dysmaturity of, 473–474edema of, 181, 294, 372, 373, 407,

409, 474examination of, 30fibrin/fibrinoid, 116, 117first-trimester, 8, 9, 11function of, 80hydropic, 7, 179, 186, 425, 429immature intermediate, 47, 48,

62, 96, 97development of, 96, 98, 99–100,

101histology of, 11morphology of, 97, 99–100

macroscopic lesions of, 40–41mature intermediate, 48, 96, 97

development of, 96, 98–99, 102,103

504 Index

Villi (cont.)medicolegal aspects of, 473–474mesenchymal, 11, 96, 97

development of, 96, 98–99morphology of, 97, 99, 100

microscopic lesions of, 60–64molar, 431necrosis of, 291–292primary, development of, 70, 73role in pregnancy

documentation, 12secondary, 73in spontaneous abortion

specimens, 14sprouting of, 85stem, 72, 96, 97

development of, 96, 98, 99, 100,101, 102

differentiated from matureintermediate villi, 48

function of, 102stroma of, 80, 85–87, 99, 100, 101,

102, 103, 104microscopic examination of,

53in villitis, 62

structure of, 80–87terminal, 47, 48, 96, 97

angiogenesis and, 342–343development of, 96, 98–99,

103–105in placental hypoxia, 343–345syncytial knots in, 48, 341–342

tertiary, 73in trisomy, 181, 183trophoblastic cover of, 99, 101,

102, 104Villitis

acute, 62, 174, 291–292chronic, 62, 297–311

in cytomegalovirus infection,297, 298, 300–302, 302

definition of, 297in herpes simplex virus

infection, 302–303in malaria, 307–308in maternal alcohol use, 327medicolegal aspects of, 468–469in mycobacterial infection, 305in parvovirus B19 infection,

303–305in syphilis infection, 297–298,

299in toxoplasmosis, 305–307

hemorrhagic, 398, 400of unknown etiology, 180, 297,

308–311, 312, 469, 480as recurrent/habitual abortion

cause, 180in systemic lupus

erythematosis, 347Villous congestion, 40, 59, 64,

358–360Villous sprouts, 73, 98, 100Villous stage, of placental

development, 73Villous tissue

color of, 31–32macroscopic examination of, 16,

30, 31–32macroscopic lesions of, 40–41routine tissue sections of, 32second-trimester, 16

Villous trees, 73during late pregnancy, 47, 48as placentones, 105–106

Viral infection, 315–317. See alsospecific Viral infections

Viruses, immunohistochemicalstains for, 54

Vitelline duct. SeeOmphalomesenteric duct

Von Willebrand’s disease, 329

WWharton’s jelly, 92, 93, 257, 326

in abnormally-inserted umbilicalcords, 265, 268

in acute chorioamnionitis, 284, 286

composition of, 92definition of, 51effect on umbilical cord diameter,

257fetal demise-associated changes

in, 387umbilical cord abnormalities, 51,

260–262Wilson’s disease, 329Wolman’s disease, 390

XX-cells. See Extravillous

trophoblast

YYolk sac, 75

primary, 77, 78remnants of, 31, 34, 58, 227, 228

in therapeutic abortionspecimens, 12, 13

secondary (extraembryonic), 77,78, 79

blood vessels of, 77, 79

ZZebra cells, 383–384Zenker’s solution, 322–323Zollinger-Ellison disease, 330Zygosity, of twins, 137–138