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Hysterectomy for placenta accreta; methods for gross and microscopic pathology examination

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Abstract

Purpose

Placenta accreta is an abnormal adherence of the placenta to the uterine wall. As the incidence of placenta accreta continues to rise, it has been useful to develop standard protocols for the diagnosis and management of affected patients. Pathologists have the opportunity to take an active role in evaluating these resource intensive protocols.

Methods

We describe methods of gross dissection, microscopic examination and reporting of hysterectomy specimens containing placenta accreta.

Results

This protocol facilitates retrospective correlation with surgical and radiographic findings as well as standardized tissue sampling for potential research.

Conclusions

Through regular review of such quality measures pathologists can give feedback on the quality of surgical planning and use of imaging.

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Author information

Authors and Affiliations

  1. Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA

    Katelyn Dannheim & Jonathan L. Hecht

  2. Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA

    Scott A. Shainker

  3. New England Center for Placental Disorders, Beth Israel Deaconess Medical Center, Boston, USA

    Scott A. Shainker & Jonathan L. Hecht

Authors
  1. Katelyn Dannheim
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  2. Scott A. Shainker
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  3. Jonathan L. Hecht
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Corresponding author

Correspondence to Jonathan L. Hecht.

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Conflict of interest

We declare that we have no conflict of Interest. All authors participated in the study design, data collection and analysis, as well as in the writing of the report and in the decision to submit the report for publication.

Appendix

Appendix

Template for gross description

The specimen is received fresh in a container labeled with the patient’s name, [NAME], the medical record number, and additionally labeled _________ [i.e., “Uterus and Placenta”]. It consists of a supracervical hysterectomy specimen (uterus without attached adnexa or cervix). The specimen weighs [WEIGHT] grams. The uterus measures ___ cm in height, ___cm from anterior to posterior, and ___ cm from cornu to cornu. There is a circular opening at the cervical excision point measuring ___ cm in diameter, with placental tissue bulging from the opening, consistent with placenta previa. There is a fresh c-section suture line at the upper portion of the uterine fundus that measures ___cm in length. The anterior lower uterine segment is externally bulging with a rough surface and dilated uterine vessels. This roughened surface measures approximately ___×___ cm without obvious rupture or hematoma. The specimen is bivalved to reveal an adhered, complete placental disc measuring ___x___x___ cm. There is a normal-appearing, three-vessel umbilical cord that measures ___ cm in length and ___ cm in diameter with an insertion ___cm from the disc edge. The cord has a left twist and a single clip. The two bivalved halves of the specimen are serially sectioned to reveal that placental tissue extends almost completely through the anterior myometrium with areas where myometrium is almost absent measuring ___x___ cm. Additional findings include multiple mural and subserosal fibroids with unremarkable, white, whorled cut surfaces, the largest measuring ___ cm in diameter. The largest fibroid is underlying the placental disc without evidence of abruption.

Template for report

  1. A.

    Uterus, supracervical hysterectomy:

    1. (a)

      Placenta increta, see note.

    2. (b)

      Leiomyomata.

Note: The placenta has an anterior implantation with invasion into the anterior lower uterine segment at the prior c-section scar without rupture.

  1. B.

    Placenta:

    1. (a)

      Placenta previa with multifocal infarction.

    2. (b)

      Unremarkable membranes and umbilical cord.

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Dannheim, K., Shainker, S.A. & Hecht, J.L. Hysterectomy for placenta accreta; methods for gross and microscopic pathology examination. Arch Gynecol Obstet 293, 951–958 (2016). https://doi.org/10.1007/s00404-015-4006-5

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  • DOI: https://doi.org/10.1007/s00404-015-4006-5

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