Gross Examination of the Placenta and Its Importance in Evaluating an Unexplained Intrauterine Fetal Demise

Abstract

AbstractPlacenta, a fascinating multifunctional organ, of fetal origin, plays a pivotal conciliatory role during pregnancy by being intimately connected to the mother and her baby. The importance of placenta is irrefutable, being an exceptional (and easily-accessible) source of information which echoes the intrauterine environment. Placental examination can shed light upon factors pertaining to the current pregnancy and its outcome, guide postpartum management, provide insight into clinical problems (such as seizures, pulmonary hypertension, renal failure) that become evident hours or days after delivery, be predictive of future pregnancies, and even play a role in medico-legal situations. The rhetoric that since most babies are normal so are the placentas, therefore an examination of all placentas may not be warranted, has fallen in disfavor and currently placental examination even for ‘routine’ deliveries is being advocated. Until such time, this becomes an established practice examination of the placenta should certainly be performed in any maternal or fetal complications and stillbirths. The placenta can provide exceedingly-useful information relating to perinatal morbidity and mortality. Furthermore, it has been shown repeatedly that a placental examination is needed to understand the causes of perinatal deaths. In order to derive clinically-useful information from the placenta, meticulous macroscopic examination is the first step. The present article describes indications whereby placental examination is warranted, mentions stepwise gross description of the placental cord, membranes, and the disk and the usefulness of placental examination in perinatal death; a figurative narration and a template for placental grossing are included.