Examination of the Placenta

  • Kurt Benirschke
  • Peter Kaufmann


Most placentas are normal, as are most neonates. Therefore an examination of all placentas is not warranted even though it has been advocated repeatedly. Salafia and Vintzileos (1991) made a strong plea for the study of all placentas by pathologists. We concur with this view, as the sporadic examination does not provide sufficient training for young pathologists, and it does not allow the routine pathologist to obtain sufficient background knowledge as to what constitutes a truly normal placenta. Another reason is the litigious climate of today (see Chapter 27). It has been shown repeatedly that a placental examination is needed in order to assess the cause of a perinatal death. Most recently this point was demonstrated especially for stillbirths by Las Heras et al. (1994). The most important lesions were found in the cord (18%), with inflammatory lesions second most common. Because placentas differ widely in shape, size, and appearance, the novice must become familiar with this spectrum of placental shapes. To do so, a large number of placentas must be examined routinely. It is therefore prudent in hospitals with large numbers of deliveries to select placentas for examination. To facilitate this practice, storage is required. The American College of Obstetricians and Gynecologists, on the other hand, has suggested that routine study of the placenta is not warranted (ACOG, 1991), a decision with which we strongly disagree.


Umbilical Cord Placental Tissue Intervillous Space Normal Placenta Single Umbilical Artery 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. ACOG: Placental Pathology. Committee Opinion. Vol. 102, pp. 1–2, 1991.Google Scholar
  2. Altshuler, G., and Hyde, S.: Fusobacteria: an important cause of chorioamnionitis. Arch. Pathol. Lab. Med. 109: 739–743, 1985.PubMedGoogle Scholar
  3. Bacsich, P., and Smout, C.F.V.: Some observations on the foetal vessels of the human placenta with an account of the corrosion technique. J. Anat. 72: 358–364, 1938.PubMedGoogle Scholar
  4. Bartholomew, R.A., Colvin, E.D., Grimes, W.H., Fish, J.S., Lester, W.M., and Galloway, W.H.: Criteria by which toxemia of pregnancy may be diagnosed from unlabeled formalin-fixed placentas. Am. J. Obstet. Gynecol. 82: 277–290, 1961.PubMedGoogle Scholar
  5. Becker, V., and Bleyl, U.: Placentarzotte bei Schwangerschaftstoxicose und fetaler Erythroblastose im fluorescenzmikroskopischen Bilde. Virchows Arch. Pathol. Anat. 334: 516–527, 1961.Google Scholar
  6. Bejar, R., Wozniak, P., Allard, M., Benirschke, K., Vaucher, Y., Coen, R., Berry, C., Schragg, P., Villegas, I., and Resnik, R.: Antenatal origin of neurologic damage in newborn infants. I. Preterm infants. Am. J. Obstet. Gynecol. 159: 357–363, 1988.Google Scholar
  7. Benirschke, K.: Examination of the placenta. Obstet. Gynecol. 18: 309–333, 1961a.Google Scholar
  8. Benirschke, K.: Twin placenta and perinatal mortality. N.Y. State J. Med. 61: 1499–1508, 1961b.Google Scholar
  9. Boe, F.: Studies on vascularization of the human placenta. Acta Obstet. Gynecol. Scand. Suppl. 5 32: 1–92, 1953.CrossRefGoogle Scholar
  10. Bouw, G.M., Stolte, L.A.M., Baak, J.P.A., and Oort, J.: Quantitative morphology of the placenta. 1. Standardization of sampling. Eur. J. Obstet. Gynecol. Reprod. Biol. 6: 325–331, 1976.CrossRefGoogle Scholar
  11. Crawford, J.M.: Vascular anatomy of the human placenta. Am. J. Obstet. Gynecol. 84: 1543–1567, 1962.PubMedGoogle Scholar
  12. Driscoll, S.G.: Choriocarcinoma: an “incidental finding” within a term placenta. Obstet. Gynecol. 21: 96–101, 1963.Google Scholar
  13. Fisher, C.C., Garrett, W., and Kossoff, G.: Placental aging monitored by gray scale echography. Am. J. Obstet. Gynecol. 124: 483–488, 1976.PubMedGoogle Scholar
  14. Fox, H.: Pathology of the Placenta. Saunders, London, 1978.Google Scholar
  15. Frank, H.G., Malekzadeh, F., Kertschanska, S., Crescimanno, C., Castellucci, M., Lang, I., Desoye, G., and Kaufmann, P.: Immunohistochemistry of two different types of placental fibrinoid. Acta Anat. (Basel) 150: 55–68, 1994.Google Scholar
  16. Fritschek, F.: Über “leere” Placentarhohlräume. Anat. Anz. 64: 65–73, 1927.Google Scholar
  17. Fujikura, T.: Placental calcification and maternal age. Am. J. Obstet. Gynecol. 87: 41–45, 1963a.PubMedGoogle Scholar
  18. Fujikura, T.: Placental calcification and seasonal difference. Am. J. Obstet. Gynecol. 87: 46–47, 1963b.PubMedGoogle Scholar
  19. Geller, H.F.: Über die Bedeutung des subchorialen Fibrinstreifens in der menschlichen Placenta. Arch. Gynecol. 192: 1–6, 1959.Google Scholar
  20. Gruenwald, P.: Examination of the placenta by the pathologist. Arch. Pathol. 77: 41–46, 1964.PubMedGoogle Scholar
  21. Gruenwald, P., and Minh, H.N.: Evaluation of body and organ weights in perinatal pathology. II. Weight of body and placenta of surviving and of autopsied infants. Am. J. Obstet. Gynecol. 82: 312–319, 1961.PubMedGoogle Scholar
  22. Heifetz, S.A.: Single umbilical artery: a statistical analysis of 237 autopsy cases and review of the literature. Perspect. Pediatr. Pathol. 8: 345–378, 1984.PubMedGoogle Scholar
  23. Hyrtl, J.: Die Blutgefässe der Menschlichen Nachgeburt Unter Normalen und Abnormen Verhältnissen. Braumüller, Vienna, 1870.Google Scholar
  24. Jauniaux, E., and Campbell, S.: Ultrasonographic assessment of placental abnormalities. Am. J. Obstet. Gynecol. 163: 1650–1658, 1990.PubMedGoogle Scholar
  25. Jeacock, M.K., Scott, J., and Plester, J.A.: Calcium content of the human placenta. Am. J. Obstet. Gynecol. 87: 34–40, 1963.PubMedGoogle Scholar
  26. Jiricka, Z., and Preslickova, M.: The effect of fixation on staining of placental tissue. Z. Versuchstierkd. 16: 127–130, 1974.PubMedGoogle Scholar
  27. Kaufmann, P.: Der osmotische Effekt der Fixation auf die Placentastruktur. Verh. Anat. Ges. 74: 351–352, 1980.Google Scholar
  28. Kaufmann, P.: Influence of ischemia and artificial perfusion on placental ultrastructure and morphometry. Contrib. Gynecol. Obstet. 13: 18–26, 1985.PubMedGoogle Scholar
  29. Las Heras, J., Micheli, V., and Kakarieka, E.: Placental pathology in perinatal deaths [abstract 26]. Mod. Pathol. 7 (1): 5P, 1994.Google Scholar
  30. Lucas, A., Christofides, N.D., Adran, T.E., Bloom, S.R., and Aynsley-Green, A.: Fetal distress, meconium, and motilin. Lancet 1: 718, 1979.PubMedCrossRefGoogle Scholar
  31. Miller, P.W., Coen, R.W., and Benirschke, K.: Dating the time interval from meconium passage to birth. Obstet. Gynecol. 66: 459–462, 1985.PubMedGoogle Scholar
  32. Moessinger, A.C., Blanc, W.A., Marone, P.A., and Polsen, D.C.: Umbilical cord length as an index of fetal activity: experimental study and clinical implications. Pediatr. Res. 16: 109–112, 1982.PubMedCrossRefGoogle Scholar
  33. Naeye, R.L.: Maternal floor infarction. Hum. Pathol. 16: 823–828, 1985.PubMedCrossRefGoogle Scholar
  34. Naeye, R.L.: Functionally important disorders of the placenta, umbilical cord, and fetal membranes. Hum. Pathol. 18: 680–691, 1987.PubMedCrossRefGoogle Scholar
  35. Panigel, M.: Placental perfusion experiments. Am. J. Obstet. Gynecol. 84: 1664–1683, 1962.Google Scholar
  36. Priman, J.: A note on the anastomosis of the umbilical arteries. Anat. Rec. 134: 1–5, 1959.PubMedCrossRefGoogle Scholar
  37. Pritchard, J.A., MacDonald, P.C., and Gant, N.F.: Williams Obstetrics. 17th ed. Appleton-Century-Crofts, Norwalk, CN, 1985.Google Scholar
  38. Reece, E.A., Scioscia, A.L., Pinter, E., Hobbins, J.C., Green, J., Mahoney, M.J., and Naftolin, F.: Prognostic significance of the human yolk sac assessed by ultrasonography. Am. J. Obstet. Gynecol. 159: 1191–1194, 1988.PubMedGoogle Scholar
  39. Salafia, C.M., and Vintzileos, A.M.: Why all placentas should be examined by a pathologist in 1990. Am. J. Obstet. Gynecol. 163: 1282–1293Google Scholar
  40. Salafia, C.M., and Vintzileos, A.M.: 1990. See also discussion Am. J. Obstet. Gynecol. 165: 783–784, 1991.Google Scholar
  41. Schatz, F.: Die Gefässverbindungen der Placentakreisläufe eineiiger Zwillinge, ihre Entwicklung und ihre Folgen. Arch. Gynecol. 27: 1–72, 1886.Google Scholar
  42. Schremmer, B.-N.: Gewichtsveränderungen verschiedener Gewebe nach Formalinfixierung. Frankfurt Z. Pathol. 77: 299–304, 1967.Google Scholar
  43. Snoeck, J.: Le Placenta Humain. Masson and Cie, Paris, 1958. Torpin, R., and Hart, B.F.: Placenta bilobata. Am. J. Obstet. Gynecol. 42: 38–49, 1941.Google Scholar
  44. Travers, H., and Schmidt, W.A.: College of American Pathologists Conference XIX on the Examination of the Placenta. Arch. Pathol. Lab. Med. 115:660–731, 1991. [a composite of many articles by numerous authors].Google Scholar
  45. Voigt, S., Kaufmann, P., and Schweikhart, G.: Zur Abgrenzung normaler, artefizieller und pathologischer Strukturen in reifen menschlichen Plazentazotten. II. Morphometrische Untersuchungen zum Einfluss des Fixationsmodus. Arch. Gynecol. 226: 347–362, 1978.PubMedCrossRefGoogle Scholar
  46. Walker, J.: Weight of the human fetus and of its placenta. Cold Spring Harbor Symp. Quant. Biol. 19: 39–40, 1954.CrossRefGoogle Scholar
  47. Zeek, P.M., and Assali, N.S.: Vascular changes in the decidua associated with eclamptogenic toxemia of pregnancy. Am. J. Clin. Pathol. 20: 1099–1109, 1950.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 1995

Authors and Affiliations

  • Kurt Benirschke
    • 1
  • Peter Kaufmann
    • 2
  1. 1.University Medical CenterUniversity of California, San DiegoSan DiegoUSA
  2. 2.Institut für Anatomie der Medizinischen FakultätRheinisch-Westfälische Technische Hochschule AachenAachenGermany

Personalised recommendations