# I need answers, and I can't decipher this thing



## L J (Apr 6, 2006)

I got the report back from the tests they ran on the placenta this week. I have been googling my rear off, but I just can't decipher it.

My appointment with the midwives isn't until the 29th of this month. I really, really don't want to wait that long to have some answers. There may not even BE any answers in this report, but if there are, I really can't find them.

I feel like I need a PH.D to even begin to understand this stuff - and I'm not uneducated, but science has never been my thing.

I'm just really frustrated. The hospital pathologist won't talk to me, they "assigned" me to a doctor since I didn't have one, and that's who the pathologist faxed the report to, who in turned faxed it to me. The pathologist wasn't even "allowed" thanks to hospital policy to deal with me directly. The doctor won't talk to me on the phone at all - his office just tells me I can make an appointment for my 6 week checkup.

My PCP is a CRNP and she is on vacation this week. I kind of this this may be beyond her realm of understanding, anyway - the only reason she is as "up" on prenatal care and pregnancy is because of me.

I'm going to The Farm for my follow up, and I feel certain that the midwives there can give me more answers than anyone else, but I just hate to wait that long. I wish there was some way for me to understand this. I have no established relationship with the midwives there, this will be my first visit, so I don't feel within my rights to call them and ask them to look at the report now.

I think this post is really just a vent. I have these papers in front of me, that may or may not tell me why my son died, and I can't figure them out. It was definitely a problem with the placenta. That much is written in plain English. I'd just like to know exactly what, and WHY? Freak of nature? Something I did wrong? Something that could occur again?

I can't just pick a doctor and go, because I have no health insurance, and since I'm no longer pregnant, I don't qualify for state health insurance. This is just so, so frustrating.


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## AnnieA (Nov 26, 2007)

I'm so sorry you have a pathology report in your hands instead of your sweet baby Jack.

Do you feel comfortable sharing some of the information that you are having trouble processing and maybe someone on here can help?


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## expatmommy (Nov 7, 2006)

How frustrating.









What does it say about the placenta?


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## L J (Apr 6, 2006)

I would be thrilled to share it on here - I just hope its not against MDC policy. I can't see where it would be, though. Here goes:

__________________________________________________ ___

The doctor did have the decency to hand write this on the report:

Quote:

The findings on this report are indicative of poor placental growth and function. This fits with the small for gestational age weight of the fetus. The infection was likely a post-demise event not a cause. CAREFUL surveillance of fetal growth warranted in future pregnancies.
This is the rest of it. Underlining is where the dr underlined w/ pen.

Diagnosis
Placenta, stillborn delivery at 35 weeks of gestation -
Third trimester, 187 g (352-516 g expected) placenta
Three-vessel umbilical cord, marginal insertion..

Chorionic meconiosis.
Evidence of intrauterine infection.
-Acute subchorionitis, chorionic plate.
Features compatible with under perfusion of placental bed.

Low placental weight of period of gestation
Laminar necrosis, decidua capsularis.
Chronic chorionic villous ischemic changes including excessive syncytial knot formation and distal villous hypoplasia.

Chronic marginal hematoma with retroplacental and subchorionic extension.

Gross and microscopic features suggestive of 1-2 days of intrauterine retention following fetal demise.

Next page, summary:

The patient is a 24 year old female with an intrauterine pregnancy at a clinically estimated period of gestation of 35 weeks. Gestational complications included: Stillborn infant.

Gross Description
The specimen is received fresh, labeled with the patient's name and medical record number. It consist of an ovoid, singleton, 187g (trimmed weight), 12.4 x 12.1 cm placenta with a 3-vessel umbilical cord. The umbilical cord is dark-maroon in color and shows marginal insertion, .5 cm away from the nearest placental margin. It now measures 28.2 cm long, 1.0 cm in diameter.

Cord vessels appear patent. True cord knots are not identified.

The fetal membranes display marginal insertion and are red-maroon in color. The point of rupture is identified 4.7 cm away from the nearest placental margin. The chorionic vessels radiate evenly and appear patent. The fetal surface shows a mild amount of subchorionic, fibrinoid deposition. The maternal surface displays ill-defined cotyledons, and a moderate amount of adherent decidua. An acute to chronic appearing 8.7 x 3.5 cm marginal hematoma is identified, that extends to affect approximately 15% of the maternal surface as a retroplacental hematoma. Serial sectioning of the placenta reveals spongy, red-brown tissue with an average mural thickness of 2.1 cm. No infarctions are identified in the parenchyma.


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## L J (Apr 6, 2006)

I understand that the placenta was too small. What I don't understand is WHY. Freak of nature? Or is it hidden somewhere in medical mumbo jumbo that I can't comprehend.

I was never told, at the hospital, that there was an infection of any kind. They told me they were giving me antibiotics preventatively.

The parts that the dr underlined are the parts that I have been trying so hard to figure out. I figure he underlined them for a reason. But, all I come up with is more medical language that my 3+ years towards a sociology degree just doesn't help me with at all. I picked the wrong thing to study, I guess.

The part about marginal cord insertion has me wondering. Is that, in and of itself, a bad thing? A normal thing? Is that part of what caused this? It just doesn't "sound" right to me. But, I'm not a doctor. All I know of placentas are what I saw of my two sons'. Henry's placenta was huge, and the cord was right in the middle. It kind of sounds like Jack's cord was inserted on the edge?


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## AnnieA (Nov 26, 2007)

O.K. from the quick searching I just did, it looks like you are correct that at least part of the problem was the marginal cord insertion. It can lead to IUGR which could explain why Jack was small. I'm not sure if that can lead to intrauterine fetal demise though.


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## jtrt (Feb 25, 2009)

Dear Laura, I am a RN and understand some of the medical terminology used in this report. I have shared my interpretation of the terms in italics. I am so sorry for the loss of your sweet Jack...

Chorionic meconiosis.
Evidence of intrauterine infection.
-Acute subchorionitis, chorionic plate. _This is the infection they are talking about. It was acute, or recent._
Features compatible with under perfusion of placental bed. _Underperfusion of placental bed suggests a lack of blood flow to the placenta where it attached to the uterus. Chronic means it was a long-standing issue, not a new event._

Low placental weight of period of gestation
Laminar necrosis, decidua capsularis.
Chronic chorionic villous ischemic changes including excessive syncytial knot formation and distal villous hypoplasia. _Ischemic changes again suggest a lack of oxygen-rich blood reached the placenta._

Chronic marginal hematoma with retroplacental and subchorionic extension. _This suggests there was a collection or pooling of blood between the uterine wall and the placenta. Chronic means it was not a new event._

Gross and microscopic features suggestive of 1-2 days of intrauterine retention following fetal demise. _This means Jack had been gone 1 or 2 days before he was born._

Next page, summary:

The patient is a 24 year old female with an intrauterine pregnancy at a clinically estimated period of gestation of 35 weeks. Gestational complications included: Stillborn infant.

Gross Description
The specimen is received fresh, labeled with the patient's name and medical record number. It consist of an ovoid, singleton, 187g (trimmed weight), 12.4 x 12.1 cm placenta with a 3-vessel umbilical cord. The umbilical cord is dark-maroon in color and shows marginal insertion, .5 cm away from the nearest placental margin. It now measures 28.2 cm long, 1.0 cm in diameter.

Cord vessels appear patent. True cord knots are not identified. _This means his umbilical cord was "open" and able to transport blood from placenta to him._

The fetal membranes display marginal insertion and are red-maroon in color. The point of rupture is identified 4.7 cm away from the nearest placental margin. The chorionic vessels radiate evenly and appear patent. The fetal surface shows a mild amount of subchorionic, fibrinoid deposition. The maternal surface displays ill-defined cotyledons, and a moderate amount of adherent decidua. *An acute to chronic appearing 8.7 x 3.5 cm marginal hematoma is identified, that extends to affect approximately 15% of the maternal surface as a retroplacental hematoma.* _The hematoma or bleed is mentioned here again._

Serial sectioning of the placenta reveals spongy, red-brown tissue with an average mural thickness of 2.1 cm. No infarctions are identified in the parenchyma.[/QUOTE]


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## kalamos23 (Apr 11, 2008)

I agree with jtrt - I was just going to write the same things. I had a retroplacental hematoma with my middle miscarriage, it is basically a placental abruption if that helps you understand it.

What it sounds like happened was that you had a marginal insertion (the cord was inserted into the placenta close to the edge and not in the middle of the placenta) and you had a chronic bleed under the placenta and in between the amnion and the chorion (the two amniotic sacs). Because of the bleed, there was more than likely some clotting. Clotting and bleeding takes away from the placental function, which is why the placenta wasn't working as well as it should.

Hematomas are not uncommon, but retroplacental hematomas (bleeds under the placenta) are really not good and should be monitored closely. The reason the doc said to monitor you more often in the next pregnancy is because if you catch a hematoma early on, there are things they can do to help it reattach and heal.

_The maternal side showed ill-defined cotyledons, and a moderate amount of adherent decidua._
This is basically saying that the placenta was not hooked up very well to your uterus and that there was some clotting. It could have been not hooked up very well because of the hematoma or because it didn't attach very well in the beginning.

((hugs))) I'm so sorry mama.


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## L J (Apr 6, 2006)

Mamas, thank you SO much for your replies. It really does help me, to have a better understanding of this report.

THANK YOU!


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## expatmommy (Nov 7, 2006)

One of the things you'll probably find as you research more, is that anecdotally many people who have had stillborn children have also had marginal insertions.

Doctors, midwives, etc will say "oh a marginal insertion is just a fluke & most of the time has no bearing on a pregnancy or delivery" but I've found that many of those who have lost children have discovered a marginal insertion post loss. I think there may be greater risk from marginal insertions & that the medical field may not be capturing that information when determining risk.

My son's umbilical cord had a marginal insertion & hemotoma similar to yours. I don't know why after 3 previous successful pregnancies, I had a 'bad' placenta & attachment. If it offers any hope, I researched all I could on healthy placental development for my subsequent pregnancy and took a bunch of different supplements and was able to carry a healthy baby to term with a strong healthy placenta even at 42 weeks.


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## Megan73 (May 16, 2007)

Quote:


Originally Posted by *expatmommy* 
My son's umbilical cord had a marginal insertion & hemotoma similar to yours. I don't know why after 3 previous successful pregnancies, I had a 'bad' placenta & attachment. If it offers any hope, I researched all I could on healthy placental development for my subsequent pregnancy and took a bunch of different supplements and was able to carry a healthy baby to term with a strong healthy placenta even at 42 weeks.

I lost my first baby to what's presumed to be a large and fast (but silent) abruption. From what I've read, abruptions can be fast - killing a baby relatively quickly - or slow, causing anemia and growth problems.
The high-risk OB I saw when I was pregnant with my healthy son said that the majority of women who abrupt don't have risk factors they cite - smoking, high blood pressure, cocaine etc. - and that in many cases it's likely to have been caused by a problem with inplantation at the very earliest stage of pregnancy.


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