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    Point-Counterpoint: Placental examination

     

     

    No. Absence of trained placental pathologists hinders accurate examination.

    Robert J. Carpenter, Jr, MD, JD, and Edwina J. Popek, DO

    Dr. Carpenter is Associate Professor, Baylor College of Medicine Department of Obstetrics and Gynecology, and Department of Molecular & Human Genetics, Center for Medical Ethics and Health Policy, Houston, Texas.

    Dr. Popek is Professor of Pathology, Baylor College of Medicine, and Director of Laboratories, Texas Children's Hospital Pavilion for Women, Houston.

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

     

    Should all placentas be saved and undergo pathological study? Dr. Raymond Redline recently thoroughly covered this topic in these pages (Placental pathology: Is it time to get serious? Contemporary OB/GYN. 2014;59(2):41–48). This excellent article covered both the “pro” and “con” positions. Here, we will give the clinician’s response.

    I (Dr. Carpenter) have worked as clinician, educator, and medico-legal reviewer for the last 35 years, and the subject of the placenta has arisen often. The information acquired from an appropriate study can often help a family who has experienced a term intrauterine fetal demise (IUFD) from an ascending infection that was not clinically recognized, or who has had an early preterm loss from placental floor infarction. In addition, I have seen many legal cases turn on the findings of the placental pathology that actually existed (and not the pathology as originally written in the clinical pathology report).

    If the US healthcare system had all the funds in the world and all placentas could be examined, the major issues would revolve around timely submission of the placenta, appropriate submission of clinical data, and most importantly, gross and microscopic evaluation of placental material by an experienced and knowledgeable pathologist.

    Not all placentas should be examined immediately. Many pregnancies are normal and evaluation of the placenta is unnecessary. The waste of both time and money that could be applied elsewhere means that the hypothesis that all placentas should be saved and examined should be rejected.

    The College of American Pathologists 1997 Guidelines as briefly summarized by Dr. Redline do yield useful categories of clinical states, both maternal and fetal/neonatal, that warrant submission of the placenta.

     

    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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