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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 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 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?