SURGICAL PATHOLOGY REPORTDate Received: 05JAN07

DIAGNOSIS:A)

Placenta and cord:1. Placenta with hypovascular villi consistent with prior fetal demise.2. Decidual tissue and membranes with focal inflammation, non-specific.3. No villitis.B)

Placenta and cord for chromosomal analysis:

Intrauterine fetal demiseKaryotype:46,XYInterpretation:Apparently normal male karyotype.There has been no evidence of growth of this specimen's fetal tissue (skin) after 10 days of culturing, but the placental tissue did grow and a 20 cell study of the placenta tissue shows anapparently normal male karyotype, Since the resulting specimen contained only placental tissue,this study does not rule out mosaicism confined to the fetus that would lead to a false negativeinterpretation of these results.PLEASE NOTE: This male karyotype carries a pericentric inversion of theheterochromatic region of one chromosome 9. This inversion Ewritten inv(9)(p12q13)) isan apparently normal chromosomal variation (polymorphism) found in approximately 2%of the general population. A large study carried out by Hsu et al. (1987) did not find anydeleterious phenotypic or clinical effect of this chromosomal polymorphism, nor of anyapparent association with fetal loss.

Thigh tissue for chromosomal analysis:

There has been no evidence of growth of this specimen’s fetal tissue (skin) after 10 days of

culturing.

ORGAN/TISSUE SITE:Placenta and cord/placenta and cord/Thigh tissue skinGROSS DESCRIPTION:A) Received is placenta, umbilical cord, and fragments of blood clot anddecidual tissue. The placenta itself measures 9.2 x 7.5 x 2 cm. It weighs 74grams. The umbilical cord is located within the central approximately 4 cmfrom the nearest margin. There is an additional approximately 38 cmumbilical cord. Twisting of the cord appears abnormal, with more twists percentimeter than average. The placenta appears somewhat disrupted. Themembranes appear smooth. The cord has three vessels evident. Sections of this are submitted. Representative sections are embedded.B)

The specimen is received in formalin labeled placenta and cord forchromosome analysis and consists of a small amount of placental tissue

aggregating to 2.5 cm in greatest dimension. The specimen is entirelysent for chromosome analysis.C)

The specimen is received in saline labeled thigh tissue skin forchromosomal analysis and consists of a 1 .2 x 0.3 x 0.2 cm aggregate of lightly tan soft tissue. The specimen is entirely sent for chromosomalanalysis.MICROSCOPIC EXAMINATIONA) The microscopic examination substantiates the diagnosis cited.B-C) Gross examination only, no microscopic examination done.

LAB RESULTS FROM FIRST LOSS (January 2007)

MICROBIOLOGYFACV V PCR+RFLP (Factor V Leiden) NegativeCOMMENTSThe sample is negative for Factor V Leiden R506Q polymorphism.Interpretive data:TEST INFORMATION: Factor V Leiden by PCR and FluorescenceMonitoring, whole blood The factor V Leiden mutation is the most commongenetic risk factor for thrombosis and accounts for greater than 90% of cases with APC resistance. Inherited thrombosis due to APC resistance isconsidered an autosomal dominant disease; heterozygote carriers of thefactor V Leiden polymorphism have an increased risk of thrombosis of five-to tenfold and homozygotes have a fifty-to hundredfold increased risk.Estimated penetrable for homozygotes is close to 80 percent with a reducedpenetrable for heterozygotes (approximately 12-20 percent).Mutations in other genes or other mutations in the factor V gene that maycause APC resistance and venous thrombosis, are not ruled out.Patient DNA was assayed for the Arg506Gln Leiden mutation in the factorV gene by polymerase chain reaction (PCR), and fluorescence monitoringusing hybridization probes.Sensitivity and specificity for detection of this mutation is 99.9 percent.NormalRangeResultsCOMPLETE BLOOD COUNT

WBC 3.8-11.0 K/CMM 9.4RBC 3.70-5.20 M/CMM 4.54HGB 11.8-15.5 GM/DL 14.3HCT 35.0-46.0 % FL 42.6MCV FL 93.9MCH 27.0-34.0 PG 31.5MCHC 32.0-36.5 GM/DL 33.5RDW 11.0-15.0 % 12.5PLT 140-450 K/CMM 245DIFFERENTIALDIFF VERIFY Normal Range ResultsABSOLUTE NEUTROPHIL 2.0-7.5 K/U 7.2NEUTROPHIL % 50.0-75.0 % 77.2LYMPH % 20.0-40.0 % 17.2MONO % 5.0-14.0 % 4.7BASOPHIL % .0-2.0 % .2EOSINOPHIL % .0-6.0 % .7COAGULATION STUDIES Normal Range ResultsPT 12.6-15.0 SEC 13.9INR 1.0 APTT 25.0-38.0 SEC 32.0 BD DIMER 0.00-0.49 ug/ml 0.32 CLUPUS INHIBITOR See DA= Recommendations for INR in warfarin therapy(Chest, Vol. 119, No. 1, Jan 2001, Supplement).Prevention and treatment of venous thrombosis; Treatment of PE;Prevention of systemic embolism due to prosthetic tissue heart valvesbileaflet ( mechanical valves in the aortic position, acute MI, valvular heartdisease and atrial fibrillation. INR 2.0-3.0Mechanical prosthetic valves, (high risk).Prevention of recurrent myocardial infarct.These recommended ranges serve as guidelines. Adjustment outside theseranges may be clinically indicated. INR 2.5-3.5