Difference between revisions of "Placental meconium"

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

Revision as of 12:54, 27 September 2013

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.

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.

Not definite

PLACENTA, UMBILICAL CORD AND FETAL MEMBRANES, CESAERIAN SECTION:
- 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.

References

↑ ALS. 6 Febraury 2009.
↑ 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.
↑ 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.
↑ 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.
↑ 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.
↑ 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.

[1] ALS. 6 Febraury 2009.

[pmid2413412-2] 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.

[pmid19031358-3] 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.

[pmid11268705-4] 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.

[1]

[2]

[3]

[4]

[5]

[6]

@@ Line 1: / Line 1: @@
-#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.
+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>
+===Not definite===
+<pre>
+PLACENTA, UMBILICAL CORD AND FETAL MEMBRANES, CESAERIAN SECTION:
+- 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]].
+==References==
+{{Reflist|2}}
+[[Category:Placenta]]
 [[Category:Diagnosis]]