By H. William Taeusch, Roberta A. Ballard, Christine A. Gleason
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Additional resources for Avery's Diseases of the Newborn, 8th Edition
CH004-023-031 6/11/2004 15:04 Page 26 26 Part II — Fetal Development TABLE 4–1 Fetal and Placental Weights Throughout Gestation Gestational Age (wks) Placental Weight (mg) Fetal Weight (g) 14 16 18 20 22 24 26 28 30 32 34 36 38 40 45 65 90 115 150 185 217 250 282 315 352 390 430 470 — 59 155 250 405 560 780 1000 1270 1550 1925 2300 2850 3400 Adapted from Benirschke K, Kaufmann P: Pathology of the Human Placenta, 4th ed. New York, Springer-Verlag, 2000. In early pregnancy the placenta covers most of the inside of the uterus.
Others remain concerned that the overall burden of treatment for both child and family remains significant, arguing that parents should continue to have a choice whether to bear that burden. In addition, some infants are born at a significant distance from an experienced center, adding the burden of transfer and perhaps family relocation to the equation. Nevertheless, it is increasingly difficult to justify the withholding of surgical treatment from infants born with HLHS in the absence of new information about an unacceptable burden of treatment or poor neurodevelopmental outcomes.
Microscopic features of the placenta, which are discovered only after preparation by the pathologist, are listed in Table 4–4, along with their associated maternal and neonatal clinical conditions. Finally, Table 4–5 summarizes the placental findings associated with acquired or genetic thrombophilia, and Table 4–6 lists the tests that should be performed for further investigation. TABLE 4–4 Microscopic Pathologic Findings in the Placenta Finding TABLE 4–3 Funisitis Gross Placental Lesions Seen in the Pathology Laboratory (Mostly Parenchymal) Lesion Possible Neonatal Outcome(s) Intervillous thrombosis Massive perivillous fibrin deposition Fetomaternal hemorrhage Intrauterine growth retardation (IUGR), asphyxia Maternal vascular disease, IUGR, asphyxia Fetal thrombophilia and sequelae Standard infarcts Stem villous arterial thrombosis–induced infarction Villitis Chorangiosis Stem villous thrombosis Listeria abscesses Abnormal villous maturation, especially acceleration Maternal vascular disease (decidua) Associated Maternal or Neonatal Conditions Fetal inflammation, cerebral palsy Transplacental (usually viral) infection, especially cytomegalovirus Fetal stress or a nonspecific finding Fetal thrombophilia, cerebral disease Preterm labor, fetal demise — Intrauterine growth retardation CH004-023-031 6/11/2004 15:04 Page 29 Chapter 4 — Placental Function and Diseases: The Placenta, Fetal Membranes, and Umbilical Cord 29 TABLE 4–7 TABLE 4–5 Lesions Associated with Acquired and Genetic Thrombophilia Placental lesions Chorionic plate vein thrombosis in absence of abnormal cord coiling Maternal floor infarction/massive perivillous fibrin deposition Stem villous arterial thrombosis–fetal induced infarction.