Download Placenta Histology Requests for Yorkhill Pathology

Placenta Histology Requests for Yorkhill Pathology.
Listed below are the data items that are required for pathological
examination of placentas. Obligatory data items are in bold and
the remainder should be added as required. Please include these
data items on the pathology request form accompanying the
placentas.
Please write clearly on the forms
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Mother’s name
Mother’s date of birth
Address
Hospital Number and CHI number
Date of delivery
Date placenta sent for pathology examination
Referring Hospital
Referring consultant
Midwife or trainee doctor’s name and contact extension / bleep number
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Gravida and Parity
GESTATION
Apgars of the baby / babies delivered
Weight of the baby / babies delivered
IUGR (Intrauterine growth restriction)
Delivery: spontaneous / induced, vaginal /
Liquor: Polyhydramnios /
forceps / ventouse / section / preterm (<36
weeks) / post term
oligohydramnios / anhydramnios /
meconium staining
Presentation: vertex / breech / cord
compression / cord prolapse
Membranes: PPROM / PROM /SROM
Infection risk: Cat 3 organisms or TORCH
Antepartum haemorrhage
Genetics: Amniocentesis / CVS / amnion
Fetal distress
AFP (normal, low, high)
Maternal history:
Maternal pyrexia
Pre-eclampsia / eclampsia
Diabetes
Other thrombophilia
Assisted conception (Clomiphene, IUI,
IVF, ICSI etc)
Cervical incompetence
Thyroid disease
Other medical conditions / drug history
Lupus
Placentation: Placenta previa / placental
abruption / placenta accreta (including
increta and percreta) etc
Ultrasound scan results
High vaginal swab: Has it been taken for
microbiology / virology?
Dysmorphism of the baby
Fetal demise / perinatal demise: If the
baby / fetus died when was the last
evidence of life? Has a postmortem
examination been requested?