Criteria for placental examination for obstetrical and neonatal providers

Abstract

Pathologic examination of the placenta can provide insight into likely (and unlikely) causes of antepartum and intrapartum events, diagnoses with urgent clinical relevance, prognostic information for mother and baby, support for practice evaluation and improvement, and insight into advancing the sciences of obstetrics and neonatology. While it is true that not all placentas require pathologic examination (although alternative opinions have been expressed), prioritization of placentas for pathological examination should be based on vetted indications such as maternal comorbidities or pregnancy complications in which placental pathology is thought to be useful for maternal or infant care, understanding pathophysiology, or practice modifications. Herein we provide placental triage criteria for the obstetric and neonatal provider based on publications and the expert opinion of sixteen placental pathologists and a pathologists' assistant using a modified Delphi approach. These criteria include those indications in which placental pathology has clinical relevance such as pregnancy losses, maternal infection, suspected abruption, fetal growth restriction, preterm birth, non-reassuring fetal heart testing requiring urgent delivery, preeclampsia with severe features, or neonates with early evidence of multiorgan system failure including neurological compromise. We encourage a focused gross examination by the provider or an attendant at delivery for all placentas and provide guidance for this examination. We recommend that any placenta which is abnormal on gross examination undergo a complete pathology examination. Additionally, we suggest practice criteria for placental pathology services including a list of critical values to be called in to the relevant provider. We hope these sets of triage indications, criteria, and practice suggestions will facilitate appropriate submission of placentas for pathologic examination and improve their relevance to clinical care.