Evaluation of the Second-Trimester Products of Conception

Abstract

Second-trimester products of conception with no history of fetal demise, anomalies, or other problems can be handled in much the same way as first trimester specimens, with documentation of intrauterine pregnancy and identification of any unexpected abnormalities. When there are fetal anomalies, additional attention is required to document the specific anomalies present and in some cases, to submit tissue for special testing. Like first trimester specimens, there is marked variability in the type of tissue received and the extent of disruption. If the specimen is delivered spontaneously or after induction of labor, the fetus may be relatively intact, although the placenta often does not survive undamaged. When surgical procedures are performed to terminate the pregnancy or remove uterine contents, both the placenta and fetus can be quite disrupted, making examination problematic. In addition, in cases of fetal demise, autolysis may further hamper evaluation. For these reasons, examination of these specimens creates unique challenges to the pathologist. Although detailed examination for fetal anomalies is beyond the scope of this text, it is the author’s hope that this chapter, covering the general approach and overview to the handling these types of specimens, will assist in initial evaluation of these specimens. The reader is referred to the Selected References at the end of the chapter for several excellent texts detailing fetal examination in the setting of congenital anomalies.