Placenta

General

Grossing-products of conception


Editorial Board Member: Ricardo R. Lastra, M.D.
Deputy Editor-in-Chief: Jennifer A. Bennett, M.D.
Sanjita Ravishankar, M.D.

Last author update: 31 May 2022
Last staff update: 31 May 2022

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PubMed Search: Placenta products of conception

Sanjita Ravishankar, M.D.
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Cite this page: Ravishankar S. Grossing-products of conception. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/placentagrossingPOC.html. Accessed February 8th, 2023.
Definition / general
  • This topic describes how to gross specimens obtained from products of conception specimens (dilation and curettage or dilation and evacuation with or without fetal parts)
  • Essential clinical history:
    • Gestational age
    • Ultrasound abnormalities
    • Presence / absence of a fetus / fetal pole
    • Abnormalities of beta hCG rise
    • Antenatal genetic testing results (i.e., noninvasive prenatal screening [NIPS])
  • Purpose of examination:
    • Identify chorionic villi or implantation site to confirm the presence of intrauterine pregnancy
      • If intrauterine pregnancy cannot be confirmed, this is a critical value and the clinician must be informed immediately, as there is risk for ectopic pregnancy
    • Evaluate villous morphology and identify abnormalities, including gestational trophoblastic disease (i.e., molar pregnancy)
    • If embryonic / fetal parts are identified, attempt to document:
      • Sex (if possible)
      • Whether growth is appropriate for gestational age
      • Any dysmorphic features or congenital anomalies
    • Collect fresh tissue for genetic / cytogenetic testing, if needed / requested
    • If procedure is being done for retained products of conception, evaluate for retained placental tissue or subinvolution of implantation site (see Placental site subinvolution)
  • References: Redline: Placental and Gestational Pathology Hardback, 1st Edition, 2018, Baergen: Manual of Pathology of the Human Placenta, 2nd Edition, 2011
Procedure
  • Remove all tissue from the specimen container and measure in aggregate
  • Separate blood clot from the soft tissue
  • Examine the soft tissue and separate the different types of tissue
    • Decidua: superficial part of the endometrium (maternal tissue)
      • Usually a pale gray-white color and often looks like a sheet
      • 1 side will be smooth while the other is rough
    • Implantation site: decidua that contains the area where the placenta implanted
      • Even if chorionic villi are absent, the presence of implantation site indicates an intrauterine pregnancy
      • Looks similar to decidua but is more yellow and somewhat firmer
    • Chorionic villi: placental tissue
      • Usually white or pink-white in color and has long finger-like projections
    • Membranes: placental tissue
      • Looks similar to membranes in mature placentas but thinner and more translucent
    • All of the above: may find an intact chorionic sac, which includes all of the above elements; may also contain umbilical cord, embryonic or fetal tissue
  • Measure the villous tissue in aggregate
  • Examine the villous tissue to determine if there is hydropic change or vesicles (see Gross images)
    • If vesicles are present, measure range of greatest dimension
  • If an embryo (< 8 weeks gestation, < 27 mm crown rump length) or fetal parts are identified:
    • Measure as many of the standard measurements as possible (crown to rump, crown to heel, head circumference, foot length)
    • Attempt to evaluate the external genitalia
      • Both male and female fetuses have an enlarged penile / clitoral swelling but females will have a vaginal orifice underneath, while males do not
    • Perform external and internal examination to evaluate for any anomalies
      • Correlation with prior ultrasound imaging can be very helpful
    • Submit sections, as considered appropriate by your institution's general practice
  • Reference: Obstet Gynecol 1986;67:79
Sections to obtain
Tips
Gross description
Gross images

Contributed by Sanjita Ravishankar, M.D.

Chorionic villi

Decidua

Decidua and chorionic villi

Complete mole with vesicles

Complete mole

Sample gross description report
  • Products of conception without chorionic villi:
    • Received (fresh, in formalin), labeled with the patient's name and hospital number and "[ ]", are multiple fragments of (pale red soft tissue, dark red-brown friable tissue) and clotted blood, aggregating to [__ x __ x __ cm]. Chorionic villi are not grossly identified. The specimen is entirely submitted in [__] cassettes.
  • Products of conception with chorionic villi:
    • Received (fresh, in formalin), labeled with the patient's name and hospital number and "[ ]", are multiple fragments of (pale red soft tissue, dark red-brown friable tissue) and clotted blood, aggregating to [__ x __ x __ cm]. Possible villous tissue is identified, measuring [__ x __ x __ cm]. A portion of the specimen is submitted for genetic analysis. Representative sections are submitted in 3 cassettes.
    • Summary of cassettes:
      • A1: possible villous tissue
      • A2: nonvillous tissue
      • A3: additional villous and nonvillous tissue
Board review style question #1

A products of conception specimen from a 41 year old woman has the gross appearance seen in the photo above. Which of the following structures is represented in the photo?

  1. Chorionic villi
  2. Decidua
  3. Fetal / embryonic tissue
  4. Implantation site
  5. Membranes
Board review style answer #1
A. Chorionic villi

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Reference: Grossing-products of conception
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