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Patoanatomisk undersøgelse af placenta

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e-Rekvisition<br />

<strong>Patoanatomisk</strong> <strong>undersøgelse</strong> <strong>af</strong> <strong>placenta</strong><br />

Maters navn Lokalt ”hoved”<br />

(<strong>af</strong>deling, ansvarlig rekvirent)<br />

CPR<br />

Indikation(er) for patoanatomisk <strong>undersøgelse</strong> <strong>af</strong> <strong>placenta</strong> (jf. Sandbjerg guideline):<br />

____________________________________________________________________<br />

____________________________________________________________________<br />

____________________________________________________________________<br />

____________________________________________________________________<br />

Gestationsalder (uger+dage): ___+____<br />

Singleton<br />

Dreng Pige F ____________<br />

ødselsvægt:<br />

Placenta (F00F) Andet: ________________________________________________<br />

Flerfold<br />

Gemelli: MC DC<br />

Trigemini<br />

Køn (D/P): ___ /___ /___ Fødselsvægt: _________ /________ / _________<br />

Placenta (F00F) Andet:_________________________________________________<br />

Forklaring på markering <strong>af</strong> navlesnore: A: __________ B: __________ C: ____________<br />

Placenta patologi<br />

Sandbjerg guideline 14/4 2013 Side 38

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