Pathology of the Human Placenta

by Benirschke, Kurt; Kaufmann, Peter; Baergen, Rebecca N.

• ISBN13: 9780387267388
• ISBN10: 0387267387
• Edition: 5th
• Format: Hardcover
• Copyright: 2006-06-01
• Publisher: Springer Verlag

Summary

Pathology of the Human Placenta remains the authoritative text in the field and is respected and used by pathologists and obstetrician-gynecologists alike. Advances in genetics and molecular biology continue to make the study of the placenta one of vast diagnostic and legal importance.New to this edition is author, Rebecca Baergen, M.D., Chief of Perinatal and Pediatric Pathology at The New York Hospital-Cornell Hospital Medical Center and author of the "Manual of Benirschke and Kaufmann's Pathology of the Human Placenta". The fifth edition reflects new advances in the field and includes 173 new color illustrations.

Table of Contents

Preface	v
Examination of the Placenta	1	(12)
Macroscopic Examination	1	(10)
Storage	1	(1)
Selection	2	(1)
Photography	2	(1)
Examination	2	(5)
Placentas of Multiple Births	7	(1)
Fixation	8	(2)
Special Procedures	10	(1)
References	11	(2)
Macroscopic Features of the Delivered Placenta	13	(3)
Fetal Surface	13	(1)
Maternal Surface	13	(2)
The Terms Fetal Placenta and Maternal Placenta	15	(1)
References	15	(1)
Microscopic Survey	16	(14)
Typical Histologic Features of the First Trimester Placenta	16	(4)
Typical Histologic Features of the Third Trimester Placenta	20	(10)
Immunohistochemical Markers	24	(6)
Placental Types	30	(12)
Placental Shapes	32	(2)
Types of Maternofetal Interdigitation	34	(1)
Maternofetal Barrier	35	(2)
Maternofetal Blood Flow Interrelations	37	(1)
Placental Types and Phylogeny	37	(1)
Human Placenta	38	(2)
References	40	(2)
Early Development of the Human Placenta	42	(8)
Prelacunar Stage	42	(2)
Lacunar Stage	44	(2)
Early Villous Stages	46	(2)
References	48	(2)
Basic Structure of the Villous Trees	50	(71)
M. Castellucci
P. Kaufmann
Syncytiotrophoblast	50	(15)
Syncytium or Multinucleated Giant Cells?	50	(4)
Syncytial Plasmalemmas and Microvilli	54	(1)
Syncytiotrophoblastic Cytoskeleton	55	(1)
Specialized Regions of the Villous Surface	55	(1)
Syncytiotrophoblast with Prevailing Rough Endoplasmic Reticulum	55	(2)
Syncytiotrophoblast with Prevailing Smooth Endoplasmic Reticulum	57	(2)
Vasculosyncytial Membranes	59	(2)
Syncytial Lamellae Covering Langhans' Cells	61	(1)
Syncytial Knots. Sprouts, and Bridges	61	(3)
Transtrophoblastic Channels	64	(1)
Trophoblastic Blebbing	64	(1)
Villous Cytotrophoblast (Langhans' Cells)	65	(7)
Cytotrophoblast Cell Types	66	(4)
Nematosomes	70	(1)
Endocrine Activities of the Villous Cytotrophoblast	70	(2)
Trophoblast Turnover and Syncytial Fusion	72	(4)
Quantitation of Trophoblast Turnover	72	(1)
Why Does Syncytiotrophoblast Survival Depend on Syncytial Fusion?	72	(1)
Trophoblastic Differentiation and Apoptosis Cascade	73	(3)
Molecular Mechanisms of Syncytial Fusion	76	(6)
Phosphatidylserine Flip as Fusion Signal	76	(1)
Junctional and Adhesion Molecules as Fusion Mediators	76	(1)
The ADAM Family of Fusogenic Proteins	76	(1)
Endogenous Retroviral Envelope Proteins of the HERV Family (Syncytins) and Their Receptors	77	(1)
Molecular Control of Syncytial Fusion	78	(1)
The Role of Oxygen and Cytokines in Trophoblast Proliferation and Fusion	79	(2)
The Impact of Trophoblast Turnover on Syncytiotrophoblast Specialization	81	(1)
Trophoblastic Basement Membrane	82	(1)
Connective Tissue	82	(5)
Mesenchymal Cells (V Cells)	82	(1)
Fibroblasts (VD Cells and VDA Cells)	83	(1)
Myofibroblasts (VDAG Cells and VDAGM Cells)	84	(2)
Matrix Components of the Villous Stroma	86	(1)
Hofbauer Cells (Villous Macrophages)	87	(6)
First Descriptions	87	(1)
Morphology	87	(3)
Occurrence and Distribution	90	(1)
Origin	90	(1)
Immunologic Aspects	91	(2)
Other Free Connective Tissue Cells	93	(1)
Basic Structure of the Vessel Walls	93	(3)
Fetal Capillaries	94	(1)
Large Fetal Vessels	94	(2)
Vasomotor Control	96	(1)
Fibrinoid of the Villous Trees	96	(3)
Perivillous Fibrinoid	96	(2)
Intravillous Fibrinoid	98	(1)
References	99	(22)
Architecture of Normal Villous Trees	121	(53)
Classification of Villous Types	121	(16)
Stem Villi	121	(5)
Immature Intermediate Villi	126	(2)
Mature Intermediate Villi	128	(1)
Terminal Villi	129	(4)
Mesenchymal Villi	133	(1)
Immunohistochemistry of Villous Types	134	(3)
Differentiation and Maturation of Villous Types	137	(3)
Development of the Mesenchymal Villi	137	(1)
Development and Fate of Immature Intermediate Villi	138	(1)
Development of Stem Villi	138	(2)
Development of the Mature Intermediate Villi	140	(1)
Development of the Terminal Villi	140	(1)
Angioarchitecture of Villi	140	(6)
Vascular Arrangement in Immature Villi	140	(1)
Larger Vessels of Stem Villi	141	(1)
Paravascular Capillary Net of Stem Villi	141	(2)
Arrangement of Vessels in Mature Intermediate and Terminal Villi	143	(2)
Sinusoids of Terminal Villi	145	(1)
Fetoplacental Angiogenesis as the Driving Force for Villous Development	146	(9)
General Aspects of Placental Vasculogenesis and Angiogenesis	147	(1)
Vasculogenesis 1: Origin of Hemangiogenic Progenitor Cells (Days 15 to 21)	148	(1)
Vasculogenesis 2: Formation of Endothelial Tubes (Days 21 to 32)	148	(5)
Angiogenesis 1: Branching Angiogenesis (Day 32 to Week 25)	153	(1)
Angiogenesis 2: Formation of Stem Vessels and Regression of Capillaries in Stem Villi (Weeks 15 to 32)	153	(1)
Angiogenesis 3: Prevailing Nonbranching Angiogenesis (Week 25 to Term)	154	(1)
Oxygen and Oxygen-Controlled Growth Factors as Regulators of Villous and Vascular Development	155	(5)
The Special Role of Oxygen in the Placenta	155	(1)
Types of Hypoxia and Its Effects on Villous Development	155	(2)
Evidence for Oxygen-Controlled Fetoplacental Angiogenesis	157	(1)
Oxygen-Controlled Angiogenic Growth Factors	157	(1)
The Timing Mismatch Between Changes in Oxygenation and Morphologic Changes	158	(1)
Oxygen and Villous Trophoblast	159	(1)
Oxygen and Villous Stroma	159	(1)
Oxygen and Intervillous Circulation	159	(1)
Hormones as Regulators of Villous Development	160	(1)
Intervillous Space as Related to the Villous Trees	160	(4)
Width of the Intervillous Space	161	(1)
Organization of Villous Trees	161	(3)
Histopathologic Importance of Inhomogeneity of Villous Trees	164	(1)
Fetomaternal Flow Interrelations	164	(1)
References	165	(9)
Characterization of the Developmental Stages	174	(17)
Stages of Development	174	(15)
Nucleated Red Blood Cells	185	(4)
References	189	(2)
Nonvillous Parts and Trophoblast Invasion	191	(122)
H. G. Frank
P. Kaufmann
Extravillous Trophoblast	191	(26)
Historical Aspects and Nomenclature	191	(2)
Extravillous Trophoblast Is a Tissue of Its Own	193	(1)
Proliferation Patterns of Extravillous Trophoblast and the Invasive Pathway	194	(2)
Stages of Extravillous Trophoblast Differentiation Within the Invasive Pathway	196	(4)
One Stem Cell Origin for Villous Syncytiotrophoblast and the Extravillous Trophoblast?	200	(1)
Cytokines and Hormones Controlling Differentiation of Extravillous Trophoblast	201	(3)
Extracellular Matrix Secretion Along the Invasive Pathway	204	(1)
Extracellular Matrix Receptors (Integrins)	204	(2)
Other Cell Adhesion Molecules and Gap Junction Molecules	206	(1)
Proteinases, Activators, and Inhibitors Involved in Trophoblast Invasion	207	(2)
Nitric Oxide and Trophoblast Invasion	209	(1)
Major Basic Protein	209	(2)
Cell Surface Carbohydrates	211	(1)
MHC Class I Molecules	212	(1)
Normal Extravillous Trophoblast Cells Are Never Proliferative and Invasive at One Time	213	(1)
Oxygen-Mediated Regulation of the Invasive Pathway	214	(1)
Extracellular pH as Trigger of Trophoblast Invasion	215	(1)
Trophoblastic Mechanisms Limiting Trophoblast Invasion	215	(1)
Endocrine Activities of Extravillous Trophoblast	216	(1)
Does Extravillous Trophoblast Differ from One Nonvillous Part to the Other?	217	(1)
Decidua	217	(9)
Composition of Decidua	217	(1)
Endometrial Stromal Cells and Decidual Cells	218	(2)
Endocrine and Paracrine Aspects of Decidua	220	(1)
Functional Considerations of Decidualization	221	(1)
B Cells and T Cells	222	(1)
Endometrial Large Granular Lymphocytes (Endometrial NK Cells and uNK Cells)	223	(1)
Macrophages	224	(1)
Glandular Residues	225	(1)
Decidual Extracellular Matrix	225	(1)
Fibrinoid	226	(7)
Definition and Historical Remarks	226	(1)
Types of Fibrinoid	227	(3)
Origin of Fibrinoids	230	(1)
Interactions Between Matrix-Type and Fibrin-Type Fibrinoid	231	(1)
Functions of Fibrinoid	231	(2)
Trophoblast Invasion as a Result of Deciduo-Trophoblastic Interactions	233	(3)
Calcification	236	(3)
Chorionic Plate	239	(4)
Development	239	(1)
Structure at Term	239	(1)
Amnion	239	(1)
Spongy Layer	240	(1)
Chorionic Mesoderm	241	(1)
Extravillous Cytotrophoblast	241	(1)
Langhans' Fibrinoid Layer	242	(1)
Marginal Zone	243	(1)
Subchorial Closing Ring	243	(1)
Trabeculae	244	(1)
Marginal Sinus	244	(1)
Basal Plate	244	(5)
Trophoblastic Shell and Development of the Basal Plate	244	(2)
Layers of the Basal Plate at Term	246	(3)
Uteroplacental Vessels	249	(12)
Development	249	(2)
Number and Position of the Uteroplacental Vessels	251	(1)
Importance of Physiologic Changes of Uteroplacental Arteries	252	(1)
Stages of Physiologic Changes in Uteroplacental Arteries	252	(2)
Sites and Routes of Endovascular Trophoblast Invasion	254	(1)
Trophoblast-Endothelial Adhesion Mechanisms	255	(1)
The Role of Macrophages in the Control of Endovascular Trophoblast Invasion	256	(1)
Incompetent Trophoblast Invasion or Exaggerated Maternal Defense as Causes for Maladaptation of Uteroplacental Arteries	257	(1)
Structure of Uteroplacental Veins	258	(2)
Intramural Fibrinoid of Uteroplacental Arteries and Veins	260	(1)
Functional Aspects of Uteroplacental Vessels	260	(1)
Septa, Cell Islands, and Cell Columns	261	(7)
Septa	261	(3)
Cell Islands	264	(1)
Cell Columns	265	(3)
Pathology of Trophoblast Invasion	268	(19)
Placenta Accreta	268	(3)
Placenta Increta and Percreta	271	(2)
Uterine Rupture	273	(2)
Placenta in Ectopic (Tubal) Pregnancy	275	(1)
Placenta in Abdominal Pregnancy	276	(1)
Cysts and Breus' Mole	277	(4)
Maternal Floor Infarction	281	(3)
Decidual Degeneration	284	(3)
References	287	(26)
Involution of Placental Site: Retained Placenta	313	(8)
Involution of the Placental Site	313	(3)
Subinvolution	316	(1)
Placental Polyps	316	(3)
Involution of a Remaining Placenta	319	(1)
References	319	(2)
Anatomy and Pathology of the Placental Membranes	321	(59)
Overview	321	(5)
Development	323	(3)
Amnion	326	(1)
Amnionic Epithelium: Different Cell Types or Cell Degeneration	327	(1)
Cytologic and Functional Aspects of the Amnionic Epithelium	327	(4)
Amnionic Fluid	330	(1)
Chromosomal Determinations	331	(1)
Cellular Metaplasia and Glycogen	331	(2)
Amnionic Mesoderm	333	(2)
A Medley of Themes	334	(1)
Clinical and Research Applications	334	(1)
Chorion Laeve	335	(1)
Intermediate (Spongy) Layer	335	(1)
Chorionic Mesoderm	335	(1)
Trophoblast Layer	336	(1)
Decidua	337	(1)
Tensile Properties of the Membranes	338	(1)
Pathology of the Membranes	338	(28)
Preterm Rupture of the Membranes	338	(2)
Cysts, Tumors, and Hemorrhage	340	(2)
Amniotic Fluid Embolism	342	(3)
Meconium	345	(9)
Gastroschisis	354	(1)
Epidermolysis Bullosa	354	(1)
Amnion Nodosum	355	(3)
Amnionic Bands	358	(6)
Extramembranous Pregnancy	364	(2)
References	366	(14)
Anatomy and Pathology of the Umbilical Cord	380	(72)
Development	380	(1)
Amnionic Epithelium	380	(1)
Wharton's Jelly	381	(2)
Structure of Umbilical Vessels	383	(2)
Innervation	384	(1)
Contractility of Umbilical Vessels	385	(1)
Hyrtl's Anastomosis, False Knots, and Hoboken Nodes	386	(2)
Allantois	388	(4)
Omphalomesenteric Duct	389	(3)
Spiral Turns of the Cord	392	(2)
Length of the Cord	394	(1)
Abnormal Length, Nuchal Cord	395	(6)
Site of Cord Insertion	401	(1)
Furcate Cord Insertion	402	(1)
Velamentous Cord Insertion	403	(4)
Placental Surface Vessels	407	(3)
Nucleated Red Blood Cells (NRBCs)	410	(1)
Cysts and Edema	411	(2)
Single Umbilical Artery	413	(2)
Placental Transfusion	415	(1)
Knots	416	(2)
False Knots	418	(1)
Strictures	419	(1)
Rupture	420	(1)
Hematoma	421	(2)
Varices and Aneurysms	423	(3)
Thrombosis of the Umbilical Vessels	426	(2)
Thrombosis of the Placental Vascular Tree	428	(6)
Tumors of the Umbilical Cord	434	(1)
References	435	(17)
Placental Shape Aberrations	452	(21)
Site of Placental Attachment	452	(2)
Volumetric Growth	454	(1)
Abnormal Shapes (``Errors in Outline'')	454	(3)
Placenta Previa	457	(5)
Placenta Membranacea	462	(2)
Circumvallate Placenta (Extrachorial, Circummarginate Placentas)	464	(4)
References	468	(5)
Histopathologic Approach to Villous Alterations	473	(18)
How to Assess Villous Histopathology	473	(7)
Assessment of Villous Maturation	473	(3)
Placental Insufficiency	476	(1)
Examination of Fetal Stem Vessels	477	(1)
Examination of the Fetal Capillary Bed	477	(1)
Villous Architecture and Fibrinoid	478	(1)
Intervillous Space, Infarcts	479	(1)
Abruptio Placentae	480	(1)
Major Histopathologic Findings	480	(8)
Syncytiotrophoblast	480	(1)
Knotting of the Syncytiotrophoblast	480	(2)
Langhans' Cells	482	(1)
Vasculosyncytial Membranes	482	(1)
Trophoblastic Basement Membrane	482	(1)
Perivillous Fibrinoid	482	(1)
Intravillous Fibrinoid	483	(1)
Villous Calcification	483	(1)
Stem Vessels	483	(1)
Nucleated Red Blood Cells	484	(1)
Villous Capillarization	484	(1)
Stromal Architecture and Stromal Fibrosis	485	(1)
Hofbauer Cells (Macrophages)	486	(1)
Inflammatory Changes	486	(1)
Villous Edema or Immaturity	486	(2)
References	488	(3)
Classification of Villous Maldevelopment	491	(28)
Three-Dimensional Interpretation of Two-Dimensional Sections	491	(6)
Syncytial Knotting: Artifact or Meaningful Pathologic Finding	491	(1)
Interpretation of Syncytial Knotting	491	(3)
Artificial Knotting as Related to Villous Shapes in Paraffin Sections	494	(3)
Conclusions Concerning Knotting	497	(1)
Classification of Villous Maldevelopment	497	(5)
Summarizing Diagram of Villous Maldevelopment	497	(3)
Villous Maturation Score	500	(2)
Cases of Villous Maldevelopment	502	(14)
Synchronous Villous Immaturity	502	(1)
Persisting Villous Immaturity and Rhesus Incompatibility	502	(2)
Normal Mature Placenta	504	(2)
Preterm Villous Maturation and Villous Hypermaturity	506	(1)
Prolonged Pregnancy	507	(1)
Placentas at High Altitude and Maternal Anemia (Preplacental Hypoxia)	508	(1)
Intrauterine Growth Restriction with Preserved End-Diastolic Umbilical Flow in the Third Trimester, with or Without Late-Onset Preeclampsia (Uteroplacental Hypoxia)	509	(2)
Intrauterine Growth Restriction Combined with Absent or Reverse End-Diastolic Umbilical Blood Flow in the Second Trimester, with or Without Early-Onset Preeclampsia (Postplacental Hypoxia)	511	(1)
Preeclampsia	512	(1)
Hellp Syndrome (Postplacental Hypoxia)	513	(2)
Maternal Diabetes Mellitus	515	(1)
References	516	(3)
Erythroblastosis Fetalis and Hydrops Fetalis	519	(33)
Erythroblastosis Fetalis	519	(1)
Placental Pathology in Erythroblastosis	520	(9)
Nonimmune Hydrops	526	(1)
α-Thalassemia	527	(2)
Fetal Hemorrhage	529	(3)
Fetal Tumors	530	(2)
Congenital Anomalies and Hydrops Fetalis	532	(1)
Congenital Heart Disease	533	(1)
Cardiac Arrhythmias	534	(1)
Nephrotic Syndrome	534	(1)
Parvovirus Anemia	535	(6)
Hydrops of Unknown Etiology	540	(1)
References	541	(11)
Transplacental Hemorrhage, Cell Transfer, Trauma	552	(25)
Transplacental Blood and Cell Transfer	552	(1)
Trauma	552	(6)
Placenta in Hemorrhage	558	(3)
Technique for Identification of Fetal Red Blood Cells	559	(2)
Significant Transplacental Hemorrhage	561	(2)
Fetal Consequences of Massive Hemorrhage Across the Placenta	563	(5)
Other Fetal Blood Elements Passing Through the Placenta	568	(1)
Mother-to-Fetus Transfer of Cells	569	(1)
References	569	(8)
Fetal Storage Disorders	577	(7)
References	582	(2)
Maternal Diseases Complicating Pregnancy: Diabetes, Tumors, Preeclampsia, Lupus Anticoagulant	584	(73)
Maternal Diseases	584	(8)
Hematologic Disorders	592	(4)
Endocrine Disorders	596	(1)
Diabetes Mellitus During Pregnancy	596	(4)
Maternal Neoplasms	600	(4)
Hypertensive Disorders	604	(21)
Preeclampsia	604	(1)
Animal Models	605	(1)
Placental Pathology of Preeclampsia	605	(1)
Decidual Arteriopathy	606	(6)
Infarcts	612	(3)
Abruptio Placentae	615	(5)
Fetal Effects of Abruptio Placentae	620	(1)
Other Placental Changes in Preeclampsia	620	(3)
Etiology of Toxemia, Pregnancy-Induced Hypertension, or Preeclampsia	623	(2)
Lupus Erythematosus and Lupus Anticoagulant	625	(9)
Lupus Erythematosus	625	(5)
Lupus Anticoagulant	630	(4)
References	634	(23)
Infectious Diseases	657	(105)
Chorioamnionitis	657	(37)
Macroscopic Appearance	657	(3)
Microscopic Appearance	660	(14)
General Considerations of Chorioamnionitis	674	(2)
Specific Microorganisms	676	(11)
Mycoplasma Hominis and Ureaplasma	687	(2)
Chlamydia Trachomatis and C Psittaci	689	(1)
Bacterial Vaginosis	690	(1)
Syphilis	690	(4)
Necrotizing Funisitis	694	(2)
Other Spirochetal Diseases	696	(1)
Fungus Infections	696	(4)
Virus Infections and Villitides	700	(16)
Cytomegalovirus Infection	700	(6)
Herpes Simplex Virus Infection	706	(3)
Varicella (Chickenpox)	709	(1)
Epstein-Barr Virus	710	(1)
Smallpox, Vaccinia, Alastrim, and Parvovirus B19	710	(2)
Enteroviruses	712	(1)
Influenza, Mumps, Rabies	712	(1)
Hepatitis	712	(1)
Rubella (German Measles) and Other Viral Infections	713	(1)
Rubeola (Measles)	714	(1)
Human Immunodeficiency Virus Infection	715	(1)
Toxoplasmosis	716	(4)
Kala-Azar	720	(1)
Chagas' Disease	720	(2)
Babesiosis, Trichomoniasis, Rickettsia, and Ehrlichia	722	(1)
Malaria	722	(2)
Other Parasitic Infections	724	(1)
Villitis of Unknown Etiology	724	(8)
References	732	(30)
Abortion, Placentas of Trisomies, and Immunologic Considerations of Recurrent Reproductive Failure	762	(35)
Anatomic Findings	764	(4)
Summary of Placental Findings in Chromosomally Defined Abortions	768	(9)
Trisomies	768	(2)
Polyploidies	770	(2)
Monosomy X	772	(1)
Induced Abortions	772	(5)
Incomplete Abortion	777	(1)
Placenta in Chorionic Villus Sampling	778	(3)
Trisomic Placentas	781	(3)
Chemical Markers and Trisomy	782	(2)
Recurrent or Habitual Abortion	784	(3)
References	787	(10)
Molar Pregnancies	797	(40)
Hydatidiform Moles and Partial Moles	797	(28)
Hydatidiform Moles	797	(14)
Other Attributes	811	(4)
Therapy	815	(2)
Partial Hydatidiform Mole	817	(8)
References	825	(12)
Trophoblastic Neoplasms	837	(26)
Choriocarcinoma	837	(6)
Choriocarcinoma in Situ and Choriocarcinoma Coincident with Pregnancy	843	(12)
Chorangiocarcinoma	846	(1)
Exaggerated Placental Site: Placental Site Nodule, Placental Site Trophoblastic Tumor, and Epithelioid Trophoblastic Tumor	846	(5)
Ultrastructure of Trophoblastic Tumors	851	(1)
Antigenic Studies of Trophoblastic Tumors	851	(1)
Epidemiology of Choriocarcinoma	852	(1)
Endocrine Aspects of Gestational Trophoblastic Neoplasia	852	(1)
Ectopic Choriocarcinomas; Tumors in Men	853	(1)
Therapy of Gestational Trophoblastic Neoplasia	854	(1)
Choriocarcinoma in Anamils	855	(1)
Choriocarcinoma in Cell Lines and Genetics	855	(1)
References	856	(7)
Benign Tumors and Chorangiosis	863	(14)
Angiomas	863	(8)
Other Benign Tumors	870	(1)
Chorangiosis and Chorangiomatosis	871	(2)
Mesenchymal Dysplasia and the Beckwith-Wiedemann Syndrome	873	(1)
References	873	(4)
Multiple Pregnancies	877	(124)
Zygosity	877	(2)
The Placenta in the Study of Zygosity	879	(6)
Causes and Incidence of Multiple Births	885	(6)
Third Type of Twin	890	(1)
Twinning Incidence	891	(2)
Superfetation and Superfecundation	893	(1)
Vascular Anatomy of Twin Placentas	893	(9)
Monoamnionic/Monochorionic Twin Placenta	902	(13)
Diamnionic/Monochorionic Twin Placenta	915	(2)
Diamnionic/Dichorionic Twin Placenta	917	(2)
Vanishing Twin Phenomenon	919	(4)
Fetus Papyraceus	923	(5)
Twin-to-Twin Transfusion Syndrome	928	(13)
Acardiac Twins	941	(9)
Conjoined Twins	950	(3)
Sacrococcygeal Teratoma and Epignathus	953	(3)
Congenital Anomalies	955	(1)
Cytogencties and Heterokaryotypic Monozygotic Twins	956	(1)
Chimerism and Mosaicism	957	(2)
Whole-Body Chimerism	959	(1)
Triplets and Higher Multiple Births	960	(7)
Twins in Abortion and Ectopic Pregnancy	967	(1)
Morbidity and Mortality	968	(3)
Hormones in Twin Pregnancy	971	(1)
References	971	(30)
Legal Considerations	1001	(15)
Twinning Problems	1004	(1)
Inflammation	1005	(2)
The Green Placenta	1007	(1)
Vascular Abnormalities	1008	(1)
Umbilical Cord	1009	(1)
Placental Villous Color	1009	(1)
Other Types of Pathology	1010	(3)
References	1013	(3)
Glossary	1016	(3)
Normative Values and Tables	1019	(8)
Index	1027