Routine Placental Histopathological Examination: Provides Answers in Neonatal Management

Abstract

Placental abnormality may affect the fetus adversely. The purpose of this study was to identify the prevalence of placental histopathological examination in a private hospital setting and analyse the placental histopathology findings for high-risk pregnancies. A retrospective cross-sectional study was conducted at the Mater Hospital in Sydney from January 2018 to June 2020. The placental histopathology was classified as per the 2014 Amsterdam Placental Workshop Group criteria, enabling uniformity for analysis. There were 5594 live births during the study period. Of these, 5% (256/5594) were low birth weight (LBW). Placental histopathology was conducted for 8% (443/5594) of the live births and 59% (152/256) of LBW births. The LBW group was subclassified into small for gestation (SGA) (n=66) and non-SGA (n=86) to analyse differences in placental abnormalities between the two groups. Of SGA, 82% (54/66) had placental abnormality compared to 76% (65/86) for non-SGA. Intervillous fibrin deposits (<i>p=0.013</i>) and smaller placental weight (<i>p=0.008</i>) were more common in the SGA; whereas the placental inflammatory-immune process was more common in the non-SGA. Original placental histopathology reports did not employ the objective Amsterdam classification system, thereby risking subjective or variable interpretation by clinicians. In conclusion, placental histopathology plays an important role in neonatal management. A quality improvement project may improve the prevalence of placental histopathological examination.