GROSS ASSESSMENT
Weight (trimmed) ________g.
Placental weight:Fetal weight ratio ________
Contour
Size ________cm x ________cm
Presence of Accessory Lobes Y N
Insertion of Cord Central
Eccentric
Marginal
Velamentous
Membranes
Membranes ruptured ________cm from the margin.
Membrane insertion
Normal
Marginal
Circum-marginate
CircumvallateMembrane character
Normal
Abnormal
Meconium stained
Blood stained
Other ______________________
Placental disc
Color
Red
Brown
Green
Pale
Other___________________________
Odor
Normal
Foul
Features
Blood clot of maternal surface _________________________
Thrombi of fetal surface ______________________________
Fibrin(oid) deposition ________________________________
estimated percentage of surface involved ____%
Infarction _________________________________________
estimated percentage of volume involved _____%
Other_____________________________________________
Cord
Length _______cm Diameter_______cm
Number of vessels _______
Features
True knot(s) ________________________________________
False knot(s) ________________________________________
Torsion/twisting _____________________________________
Engorgement ________________________________________
Narrowing/constriction ________________________________
location ______________________________________
Abnormal Wharton's jelly ______________________________
_____________________________________________
If Twins:
Membrane Configuration
Monochorionic-Monoamniotic
Monochorionic-Diamniotic
Dichorionic-DiamnioticPlacental Vessels
Anastomotic vessels evident by gross inspection
Anastomotic vessels demonstrated by injection/perfusion
HISTOLOGIC ASSESSMENT
Sections should be obtained as follows:
1. Cross section of umbilical cord
1b. Cross section just proximal to and just distal to any apparent cord constriction or cord stricture
2. Amniochorionic membrane roll
3. Fetal side placenta
4. Basal placenta
5. Sampling of any apparent abnormalities.
Reporting should include general description of each section and description (including severity and extent) of
Inflammation
Chorioamnionitis ______________________________________________
Cord Vasculitis _______________________________________________
Funisitis ____________________________________________________
Villitis ______________________________________________________
Infarction __________________________________________________________
Calcification(s) ______________________________________________________
Fibrin Deposition ____________________________________________________
Other _____________________________________________________________
____________________________________________________________
