Appendix A

Cytogenetic Studies and Microbiology in Stillborn Investigation

Cytogenetic Studies

Criteria

Placental tissue samples should be taken immediately after delivery on all stillborns and sent for cytogenetic studies if:

  • There is evidence of:
    • Congenital malformation of any type
    • Intrauterine growth restriction
    • Hydrops
    • Oligohydramnios/polyhydramnios
    • Ambiguous genitalia
    • Dysmorphic features
    • A parent is known carrier of a chromosome re-arrangement
  • The parents have a history of any of the following:
    • Repeated miscarriages
    • Past stillbirths
    • Past neonatal deaths
    • Previous child with congenital anomalies

Collection of Placenta Tissue for Cytogenetic Studies

Placental Sampling for Cytogenetic Studies

Following delivery of the placenta and prior to sending the placenta to pathology, a sample of placenta tissue should be collected on all stillborns and stored until the clinican or pathologist decides if the specimen will be sent to cytogenetic studies.

  • To Collect: Collect the placenta tissue sample from the fetal side by the site of cord insertion beneath the amnion as per Figure 1. Remove 1 cm3 of placenta tissue with a sterile surgical knife and dissecting forceps. The sample should be placed in sterile saline or other appropriate tissue culture media sealed and labeled. Ensure that the media container is completely filled as the sample may stick to the lid of the container in transport.
  • To Store: If necessary, the sample can be stored in the fridge at 4° centigrade. DO NOT FREEZE. (The length of time the specimen can be stored should be determined locally in conjunction with the genetics laboratory).
  • To Send: Transport to the cytogenetics laboratory promptly.

Handling of Cytogenetic Specimens

Send specimens to lab as soon as possible.

Medical Genetics Laboratory
CALGARY AB
403.955.7375
OR
Cytogenetics Laboratory
EDMONTON AB
780.407.1542

Microbiology

Placenta Tissue

  • Using sterile technique collect and send placenta tissue culture for GBS, Listeria, Enterovirus and CMV (check with laboratory for appropriate culture media).
  • To collect – swab surface of placenta membranes prior to cutting through to tissue and then swab surface of tissue prior to collecting sample as per procedure for cytogenetic sampling.

Maternal

  • Obtain a maternal blood sample and send for syphilis; maternal IgG and IgM for parvovirus; CMV; rubella and toxoplasmosis
  • Obtain maternal blood culture – 5 ml in an aerobic vial and 5 ml in an anaerobic vial
  • Consider a maternal HIV test and TB skin test
  • Complete cytogenetic requisition form
  • Label all vials
  • Pack in specimen transport containers. If there is danger of extreme cold or heat during transport, ensure sample is properly insulated.