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    Point-Counterpoint: Placental examination

     

    Yes. Adopting the guidelines at the institutional level will maximize care.

     

    Vlad D. Ianus, MD, MPH, and Sharon T. Phelan, MD

    Dr. Ianus is Assistant Professor of Pediatrics
, Division of Neonatology, 
University of New Mexico Children's Hospital, 
Albuquerque.

    Dr. Phelan is Professor, Department of Obstetrics and Gynecology, University of New Mexico, Albuquerque.

    Neither author has a conflict of interest to disclose with respect to the content of this article.

     

    The placenta, which plays a central role during gestation, can offer important information regarding a pregnancy, several perinatal conditions, the well-being of the neonate, and the prognosis of future pregnancies. Obstetric morbidities and changes in the uterine environment are often reflected in the placental examination findings. Some of these findings (eg, chorioamnionitis) correlate highly with long-term developmental outcomes of the infant that may not be accurately predicted by a clinical diagnosis alone.

    Placental examination reveals abnormal findings in almost all cases of fetal death, and the pathology report can diagnose the cause of death in about one-third of the cases in which it could not be determined clinically. Lastly, data resulting from a placental examination may offer essential evidence in medical liability cases.

    Issued in 1997 by the College of American Pathologists (CAP), a Practice Guideline for Examination of the Placenta (PGEP) remains one of the most comprehensive and current recommendations regarding the topic.1

    Yet studies that investigated adherence to the PGEP revealed that fewer than half the placentas that met criteria were sent to pathology.2-5 Several explanations for this are possible, but improved adherence to the guidelines can be achieved by refrigerating placentas for several days before discarding them. That allows both the obstetrical and pediatric practitioners the chance to request in-depth examination of a placenta based on clinical information that might have been unavailable or overlooked at the time of delivery or based on changes in neonatal circumstances that develop early in postnatal life.6

     

    Sharon T. Phelan, MD
    Dr. Phelan is a Professor in the Department of Obstetrics and Gynecology, University of New Mexico, Albuquerque.

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