|
Pediatric & Perinatal |
Fetus and Embryo |
Click the section headings (in blue) to expand or collapse the content
Guideline & Procedure:
- Record clinical data according to the surgical pathology request. Emphasize parity, gravidity, gestational age, previous and current pregnancy loss, and pregnancy details, e.g. bleeding, maternal illness, and exposure to drugs or teratogens.
- Identify the source as spontaneous, ectopic, or induced. If induced, specify the indication and method.
- Embryo: conception to 8 weeks, 56 days, 3.0 cm CR length
- Fetus: 8 weeks until delivery
- Abortus and stillbirth: Because of variation in size and weight, the attending physician’s designation of gestational age takes priority in defining an abortus or stillbirth.
- Abortus:
a. Fetal death < 20 weeks gestation, <450 g, <18 cm CR
b. Treat as a surgical pathology specimen - Stillbirth:
a. Fetal death > 20 weeks gestation, >450 g, >18 cm CR
b. Post mortem examination requires the customary authorization. - Live born::
a. Alive born infant with an Apgar score of 1 or greater is never a surgical specimen no matter the gestational stage, size, or weight.
b. Post mortem examination requires the customary authorization.
- Photograph all fetuses and embryos, emphasizing any abnormalities, as these are essential to consulting dysmorphologists.
- Obtain a radiograph, using the Faxitron instrument, to identify bone growth abnormalities, e.g. TORCH, syphilis.
- If dysmorphic, obtain tissue for cytogenetics.
- Embryo:
- CR length and weight
- Fix and section transversely
- Abortus:
- Body weight
- Measurements: CR, CH, right foot, circumferences of head, thorax, and abdomen.
- External examination:
|
Skin |
Abdomen |
|
Head and neck, eyes, ears |
Spine |
|
Extremities |
External genitalia |
|
Thorax |
|
- Internal examination:
|
Palate and tongue |
Liver |
Gonads |
|
Thyroid |
Spleen |
Bladder |
|
Thymus |
Gut and mesentery |
Internal genitalia |
|
Lungs |
Adrenals |
Pancreas |
|
Heart and great arteries |
Kidneys and ureters |
|
- Dissect thoracic, abdominal, and cranial organs. Weigh each organ; weigh paired organs together.
- Estimate developmental age from CR length. Recognize that developmental age will be 14 days less than gestational age based on LMP.
- After fixation, prepare blocks for histology from the dissected thoracic, abdominal, and cranial organs.
Suggested Sections for Histology:
One section of each internal organ in a separate cassette. Start by opening the chest and abdomen with a Y-shaped incision (as in the adult autopsy). Get the gonads first as they are the smallest and easiest to lose during dissection.
Internal use only
Gross Measurements:
Head circumference: ____ cm Chest circumference: ____ cm
Abdomen circumference: ____ cm Foot length: ____ cm
Crown heel length: ____ cm Crown rump length: ____ cm
Umbilical cord: length = ____ cm diameter = ____ cm Number of vessel = ___
Weights: Total body weight = ______ grams
Brain: _____ grams Spleen: _____ grams Liver: _____ grams
Heart: _____ grams Lungs and heart combined: _____ grams
Right lung: _____ grams Left lung: _____ grams
Right adrenal: _____ grams Left adrenal: ___ grams
Right kidney: _____ grams Left kidney: _____ grams
External abnormalities: ___ No ___ Yes (specify) below:
______________________________________________________________________
______________________________________________________________________
Internal: (circle those that apply)
Brain: Normal Abnormal: __________________________________
Thymus: Normal Abnormal: __________________________________
Lungs: Normal Abnormal: __________________________________
Heart: Normal Abnormal: __________________________________
Great vessels: Normal Abnormal: __________________________________
Diaphragm: Normal Abnormal: __________________________________
Liver: Normal Abnormal: __________________________________
Pancreas: Normal Abnormal: __________________________________
Stomach: Normal Abnormal: __________________________________
Intestines: Normal Abnormal: __________________________________
Spleen: Normal Abnormal: __________________________________
Adrenals: Normal Abnormal: __________________________________
Kidneys & ureters: Normal Abnormal: __________________________________
Bladder: Normal Abnormal: __________________________________
Gonads:
___ Female: Normal Abnormal: __________________________________
___ Male: Normal Abnormal: __________________________________
Describe abnormalities: _________________________________________________
________________________________________________________________
Maceration: ___ No ___ Yes (specify degree): _____________________________
Gross impression: (e.g. sex, gestational age, any syndrome) ___________________
________________________________________________________________
Section Code: Use separate sheet.