Difference between revisions of "Placental meconium"

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#redirect [[Placenta#Placental meconium]]
{{ Infobox diagnosis
| Name      = {{PAGENAME}}
| Image      = Meconium-laden_macrophages_high_mag.jpg
| Width      =
| Caption    = Meconium-laden macrophages. [[H&E stain]].
| Micro      = macrophages with brown fine granular pigment in the amnion +/- chorion
| Subtypes  =
| LMDDx      = hemorrhage
| Stains    = PASD +ve, Prussian blue -ve
| IHC        =
| EM        =
| Molecular  =
| IF        =
| Gross      = green discolourization of fetal membranes
| Grossing  =
| Site      = [[placenta|placental membranes]]
| Assdx      = +/-[[chorioamnionitis]]
| Syndromes  =
| Clinicalhx = +/-non-reassuring fetal heart rate
| Signs      =
| Symptoms  =
| Prevalence = uncommon
| Bloodwork  =
| Rads      =
| Endoscopy  =
| Prognosis  = benign
| Other      =
| ClinDDx    =
}}
'''Placental meconium''', also known as '''meconium staining''', is associated with fetal distress.


==General==
*Associated with fetal distress.
*Small amount - at term - is considered to be normal.
Other meconium-related pathology:
*[[Meconium peritonitis]].
*[[Meconium ileus]].
==Gross==
*Fetal membranes with a green discolourization.
==Microscopic==
Features:<ref>ALS. 6 Febraury 2009.</ref>
*Meconium histiocytes - '''key feature'''.
**Macrophages with brown fine granular pigment.
*Pseudostratified epithelium (amnion) - low power.
*Amnion - columnar morphology (normally cuboidal).
*"Drop-out" of individual amnion cells / loss of individual cells.
Time of meconium passage:<ref name=pmid2413412>{{cite journal |author=Miller PW, Coen RW, Benirschke K |title=Dating the time interval from meconium passage to birth |journal=Obstet Gynecol |volume=66 |issue=4 |pages=459–62 |year=1985 |month=October |pmid=2413412 |doi= |url=}}</ref>
*<1 h - no staining of membranes.
*1-3 h - amnion is stained.
*>3 h - chorion is stained.
DDx:
*Hemosiderin-laden macrophages.
**This is sorted-out with an iron stain -- see below.
*[[Chorioamnionitis]] - apoptotic cells may be mistaken for [[neutrophils]].
Notes:
*The above time course is disputed - in vitro experiments suggest it is considerably longer.<ref name=pmid19031358>{{cite journal |author=Funai EF, Labowsky AT, Drewes CE, Kliman HJ |title=Timing of fetal meconium absorption by amnionic macrophages |journal=Am J Perinatol |volume=26 |issue=1 |pages=93–7 |year=2009 |month=January |pmid=19031358 |doi=10.1055/s-0028-1103028 |url=}}</ref>
===Images===
<gallery>
Image:Meconium-laden_macrophages_high_mag.jpg | Meconium-laden macrophages - high mag. (WC)
Image:Meconium-laden_macrophages_intermed_mag.jpg | Meconium-laden macrophages - intermed. mag. (WC)
</gallery>
==Special stains==
*Hemosiderin +ve in hemosiderin-laden macrophages.
*PAS +ve in meconium-laden macrophages.<ref name=pmid11268705>{{cite journal |author=Povýsil C, Bennett R, Povýsilová V |title=CD 68 positivity of the so-called meconium corpuscles in human foetal intestine |journal=Cesk Patol |volume=37 |issue=1 |pages=7–9 |year=2001 |month=January |pmid=11268705 |doi= |url=}}</ref>
Useful to differentiate hemosiderin-laden macrophages and meconium laden macrophages:
*Hemosiderin stain -- +ve for old blood.
**Prussian-blue stain = hemosiderin stain.<ref>{{cite journal |author=Sienko A, Altshuler G |title=Meconium-induced umbilical vascular necrosis in abortuses and fetuses: a histopathologic study for cytokines |journal=Obstet Gynecol |volume=94 |issue=3 |pages=415?0 |year=1999 |month=September |pmid=10472870 |doi= |url=}}</ref>
Notes:
*PAS-D -- +ve in meconium... though may rarely stain hemosiderin.
*Meconium contains bile.<ref>{{cite journal |author=Sienko A, Altshuler G |title=Meconium-induced umbilical vascular necrosis in abortuses and fetuses: a histopathologic study for cytokines |journal=Obstet Gynecol |volume=94 |issue=3 |pages=415?0 |year=1999 |month=September |pmid=10472870 |doi= |url=}}</ref>
==Sign out==
<pre>
PLACENTA, UMBILICAL CORD AND FETAL MEMBRANES, BIRTH:
- FETAL MEMBRANES WITH MECONIUM-LADEN MACROPHAGES, NEGATIVE FOR CHORIOAMNIONITIS.
- THREE VESSEL UMBILICAL CORD WITHIN NORMAL LIMITS.
- PLACENTAL DISC WITH THIRD TRIMESTER VILLI WITHIN NORMAL LIMITS.
</pre>
<pre>
COMMENT:
A PAS-D stain and Prussian blue stain were used to confirm the presence of meconium.
</pre>
===Degenerative changes present===
<pre>
PLACENTA, UMBILICAL CORD AND FETAL MEMBRANES, BIRTH:
- FETAL MEMBRANES WITH MECONIUM-LADEN MACROPHAGES AND DEGENERATIVE CHANGES,
  NEGATIVE FOR CHORIOAMNIONITIS.
- THREE VESSEL UMBILICAL CORD WITHIN NORMAL LIMITS.
- PLACENTAL DISC WITH THIRD TRIMESTER VILLI WITHIN NORMAL LIMITS.
</pre>
===Not definite===
<pre>
PLACENTA, UMBILICAL CORD AND FETAL MEMBRANES, BIRTH:
- EARLY CHORIOAMNIONITIS.
- FETAL MEMBRANES WITH FOCAL AMNION CELL DROP-OUT AND RARE PIGMENTED
  CELLS SUGGESTIVE OF MECONIUM.
- THREE VESSEL UMBILICAL CORD WITHIN NORMAL LIMITS.
- PLACENTAL DISC WITH THIRD TRIMESTER VILLI.
</pre>
==See also==
*[[Placenta]].
*[[Chorioamnionitis]].
*[[Meconium peritonitis]].
*[[Meconium ileus]].
==References==
{{Reflist|2}}
[[Category:Placenta]]
[[Category:Diagnosis]]
[[Category:Diagnosis]]

Latest revision as of 22:24, 10 January 2015

Placental meconium
Diagnosis in short

Meconium-laden macrophages. H&E stain.
LM macrophages with brown fine granular pigment in the amnion +/- chorion
LM DDx hemorrhage
Stains PASD +ve, Prussian blue -ve
Gross green discolourization of fetal membranes
Site placental membranes
Associated Dx +/-chorioamnionitis
Clinical history +/-non-reassuring fetal heart rate
Prevalence uncommon
Prognosis benign

Placental meconium, also known as meconium staining, is associated with fetal distress.

General

  • Associated with fetal distress.
  • Small amount - at term - is considered to be normal.

Other meconium-related pathology:

Gross

  • Fetal membranes with a green discolourization.

Microscopic

Features:[1]

  • Meconium histiocytes - key feature.
    • Macrophages with brown fine granular pigment.
  • Pseudostratified epithelium (amnion) - low power.
  • Amnion - columnar morphology (normally cuboidal).
  • "Drop-out" of individual amnion cells / loss of individual cells.

Time of meconium passage:[2]

  • <1 h - no staining of membranes.
  • 1-3 h - amnion is stained.
  • >3 h - chorion is stained.

DDx:

  • Hemosiderin-laden macrophages.
    • This is sorted-out with an iron stain -- see below.
  • Chorioamnionitis - apoptotic cells may be mistaken for neutrophils.

Notes:

  • The above time course is disputed - in vitro experiments suggest it is considerably longer.[3]

Images

  • Meconium-laden macrophages - high mag. (WC)

  • Meconium-laden macrophages - intermed. mag. (WC)

Special stains

  • Hemosiderin +ve in hemosiderin-laden macrophages.
  • PAS +ve in meconium-laden macrophages.[4]

Useful to differentiate hemosiderin-laden macrophages and meconium laden macrophages:

  • Hemosiderin stain -- +ve for old blood.
    • Prussian-blue stain = hemosiderin stain.[5]

Notes:

  • PAS-D -- +ve in meconium... though may rarely stain hemosiderin.
  • Meconium contains bile.[6]

Sign out

PLACENTA, UMBILICAL CORD AND FETAL MEMBRANES, BIRTH:
- FETAL MEMBRANES WITH MECONIUM-LADEN MACROPHAGES, NEGATIVE FOR CHORIOAMNIONITIS.
- THREE VESSEL UMBILICAL CORD WITHIN NORMAL LIMITS.
- PLACENTAL DISC WITH THIRD TRIMESTER VILLI WITHIN NORMAL LIMITS.

COMMENT:
A PAS-D stain and Prussian blue stain were used to confirm the presence of meconium.

Degenerative changes present

PLACENTA, UMBILICAL CORD AND FETAL MEMBRANES, BIRTH:
- FETAL MEMBRANES WITH MECONIUM-LADEN MACROPHAGES AND DEGENERATIVE CHANGES, 
  NEGATIVE FOR CHORIOAMNIONITIS.
- THREE VESSEL UMBILICAL CORD WITHIN NORMAL LIMITS.
- PLACENTAL DISC WITH THIRD TRIMESTER VILLI WITHIN NORMAL LIMITS.

Not definite

PLACENTA, UMBILICAL CORD AND FETAL MEMBRANES, BIRTH:
- EARLY CHORIOAMNIONITIS.
- FETAL MEMBRANES WITH FOCAL AMNION CELL DROP-OUT AND RARE PIGMENTED
  CELLS SUGGESTIVE OF MECONIUM.
- THREE VESSEL UMBILICAL CORD WITHIN NORMAL LIMITS.
- PLACENTAL DISC WITH THIRD TRIMESTER VILLI.

See also

References

  1. ↑ ALS. 6 Febraury 2009.
  2. ↑ Miller PW, Coen RW, Benirschke K (October 1985). "Dating the time interval from meconium passage to birth". Obstet Gynecol 66 (4): 459–62. PMID 2413412.
  3. ↑ Funai EF, Labowsky AT, Drewes CE, Kliman HJ (January 2009). "Timing of fetal meconium absorption by amnionic macrophages". Am J Perinatol 26 (1): 93–7. doi:10.1055/s-0028-1103028. PMID 19031358.
  4. ↑ Povýsil C, Bennett R, Povýsilová V (January 2001). "CD 68 positivity of the so-called meconium corpuscles in human foetal intestine". Cesk Patol 37 (1): 7–9. PMID 11268705.
  5. ↑ Sienko A, Altshuler G (September 1999). "Meconium-induced umbilical vascular necrosis in abortuses and fetuses: a histopathologic study for cytokines". Obstet Gynecol 94 (3): 415?0. PMID 10472870.
  6. ↑ Sienko A, Altshuler G (September 1999). "Meconium-induced umbilical vascular necrosis in abortuses and fetuses: a histopathologic study for cytokines". Obstet Gynecol 94 (3): 415?0. PMID 10472870.
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