Anatomical and Histopathologic Analysis of Placenta in Dilation and Evacuation Specimens


Background: Anatomical and histopathologic examination of placenta in cases of abortion is crucial as to clarify the underlying causes of many adverse pregnancy outcomes. Dilation and evacuation (D&E) is the most common mode of uterine evacuation that commonly examined in pathology sections. The aim of this study is to discuss the various placental pathologies, and to demonstrate the importance of careful pathologic examination of D&E material, also to review the anatomy of placenta and to compare our findings with other publications worldwide. Material and Methods: A retrospective descriptive study for 200 placental tissues was collected in 18 months period and revised for normal anatomy and various placental pathologies. These placentas were obtained by dilation and evacuation (D&E) technique. All cases were undergone for histopathological sections that were stained by Hematoxylin and Eosin (H&E). Results: Placental infarction was observed in 25% of cases, and chorioammnitis was the most common form of placental infection and found in 12.5%. Molar changes were represented a lowered percentage of placental pathologies that found in 9% of specimens. Conclusion: Study and recognition of placental lesions among general surgical pathologists have clinical significance and awareness of deficiency, standardization of diagnostic criteria, and increased knowledge in placental pathology improve the quality of diagnosis in this area.

Share and Cite:

Hassan, T. , Hegazy, A. and Mosaed, M. (2014) Anatomical and Histopathologic Analysis of Placenta in Dilation and Evacuation Specimens. Forensic Medicine and Anatomy Research, 2, 17-27. doi: 10.4236/fmar.2014.22005.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Sadler, T.W. (2012) Fetal Membranes and Placenta. In: Langman’s Medical Embryology, 12th Edition, Wolters Kluwer, Philadelphia, 96-101.
[2] Lanir, N., Aharon, A. and Brenner, B. (2003) Haemostatic Mechanisms in Human Placenta. Best Practice & Research Clinical Haematology, 16, 183-195.
[3] Fox, H. (1999) Development of Placenta and Membranes. In: Dewhursts, J., Deswiet, M. and Chamberlain, G., Eds., Basic Sciences in obstetrics and Gynecology, Churchill Living Stone, Philadelphia.
[4] Vijay, V. (1994) Joshi. Handbook of Placental Pathology. 2nd Edition, IGaku-Shoin, New York.
[5] Christopher, P.C. (2004) The Female Genital Tract. In: Cotran, R.S., Kumar, V. and Collins, T., Eds., Pathologic Basis of Disease, 7th Edition, WB Saunders, Philadelphia, 1079-1080.
[6] Roberts, D.J and Oliva, E. (2006) Clinical Significance of Placental Examination in Perinatal Medicine. Journal of Maternal-Fetal and Neonatal Medicine, 19, 255-264.
[7] Sun, C.J., Revell, V.O., Belli, A.J. and Viscardi, R.M. (2002) Discrepancy in Pathologic Diagnosis of Placental Lesions. Archives of Pathology & Laboratory Medicine, 126, 706-709.
[8] Ernst L.M., M.D., Gawron L., and Fritsch M.K. (2013) Pathologic Examination of Fetal and Placental Tissue Obtained by Dilation and Evacuation. Archives of Pathology & Laboratory Medicine, 137, 326-337.
[9] Fox, M.C. and Krajewski, C.M. (2013) Cervical Preparation for Second-Trimester Surgical Abortion Prior to 20 Weeks’ Gestation: SFP Guideline #2013-4. Contraception, 89, 75-84.
[10] Fram, K.M. (2002) Histological Analysis of the Products of Conception Following First Trimester Abortion at Jordan University Hospital. The European Journal of Obstetrics & Gynecology and Reproductive Biology, 105, 147-149.
[11] Hackney, D.N., Tirumala, R., Salamone, L.J, Miller, R.K. and Katzman, P.J. (2013) Do Placental Histologic Findings of Chorion-Decidual Hemorrhage or Inflammation in Spontaneous Preterm Birth Influence Outcomes in the Subsequent Pregnancy? Placenta, 35, 58-63.
[12] Petersen, O.M., Heller, D.S. and Joshi, V.V. (2006) Handbook of Placental Pathology. Taylor and Francis, Oxford.
[13] Katzman, P.J. and Genest, D.R. (2002) Maternal Floor Infarction and Massive Perivillous Fibrin Deposition: Histological Definitions, Association with Intrauterine Fetal Growth Restriction, and Risk of Recurrence. Pediatric and Developmental Pathology, 5, 159-164.
[14] Sebire, N.J., Backos, M., El Gaddal, S., Goldin, R.D. and Regan, L. (2003) Placental Pathology, Antiphospholipid Antibodies, and Pregnancy Outcome in Recurrent Miscarriage Patients. Obstetrics & Gynecology, 101, 258-263.
[15] Redline, R.W. (2012) Inflammatory Response in Acute Chorioamnionitis. Seminars in Fetal & Neonatal Medicine, 17, 20-25.
[16] Redline, R., Faye-Petersen, O., Heller, D., Qureshi, F., Savell, V. and Vogler, C. (2003) Amniotic Infection Syndrome: Nosology and Reproducibility of Placental Reaction Patterns. Pediatric and Developmental Pathology, 6, 435-448.
[17] Kraus, F.T., Redline, R.W., Gersell, D.J., Nelson, D.M. and Dicke, J.M. (2004) Placental Pathology. In: Atlas of Non- tumor Pathology, AFIP, Washington DC, 75-115.
[18] Benirschke, K.K.P. and Baergen, R.N. (2006) Pathology of the Human Placenta. 5th Edition, Springer, New York.
[19] Goldenberg, R.L., Culhane, J.F., Iams, J.D. and Romero, R. (2008) Epidemiology and Causes of Preterm Birth. Lancet, 371, 75-84.
[20] Habek, D. (2011) Multiple Intraplacental Hematomas—Kline’s Hemorrhage. Case Report. Acta Clinica Croatica, 50, 423-425.
[21] Sarin, A.R., Kaur, B., Modi, S. and Popli, R. (1993) Histopathological Changes in Placenta in Early Pregnancy Wastage. Indian Journal of Maternal and Child Health, 4, 75-77.
[22] Fox, H. and Sebire, N.J. (2007) Pathology of the Placenta-Major Problems in Pathology, 3rd Edition, Saunders-Elsevier, China.
[23] Soma, H., Murai, N., Tanaka, K., Oguro, T., Kokuba, H., Fujita, K. and Mineo, S. (2013) Angiogenesis in Villous Chorangiosis Observed by Ultrastructural Studies. Medical Molecular Morphology, 46, 77-85.
[24] Emmrich, P. (1992) Pathology of the Placenta. X. Syncytial Proliferation, Calcification, Cysts, Pigments and Metabolic Disorders. Zentralblatt für Pathologie, 138, 77-84.
[25] Lu, H., Guo, Y.N., Liu, S.N. and Zhang, D.C. (2012) Nanobacteria May Be Linked to Calcification in Placenta. Ultra-structural Pathology, 36, 160-165.
[26] Edmondson, N., Bocking, A., Machin, G., Rizek, R., Watson, C. and Keating, S. (2009) The Prevalence of Chronic Deciduitis in Cases of Preterm Labour without Clinical Chorioamnionitis. Pediatric and Developmental Pathology, 12, 16-21.
[27] Szulman, A.E. (1991) Examination of the Early Conceptus. Archives of Pathology & Laboratory Medicine, 115, 696- 700.
[28] Berkowitz, R.S., Goldstein, D.P. and Bemstein, M.R. (1985) Natural History of Partial Molar Pregnancy. Obstetrics and Gynecology, 66, 677-681.
[29] Bagshawe, K.D., Lawler, S.D., Paradinas, F.J., Dent, J., Brown, P. and Boxer, G.M. (1990) Gestational Trophoblastic Tumours Following Initial Diagnosis of Partial Hydatidiform Mole. Lancet, 335, 1074-1076.
[30] Rice, L.W., Berkowitz, R.S., Lage, J.M., Goldstein, D.P. and Bernstein, M.R. (1990) Persistent Gestational Trophoblastic Tumor after Partial Hydatidiform. Gynecologic Oncology, 36, 358-362.
[31] Szulman, A.E. (1988) Trophoblastic Disease: Clinical Pathology of Hydatidiform Moles. Obstetrics and Gynecology Clinics of North America, 15, 443-456.

Copyright © 2022 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.