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    Point-Counterpoint: Placental examination


    I have been fortunate over the past 35 years to have at least 2 superb placental pathologists whom I have relied on and trusted. The data acquired in our institution are excellent. In the hospitals in which I have practiced over the past 10 a policy of placental storage for 7 days is in place. If an acute neonatal problem presents, and the placenta was not previously submitted to pathology, the placenta is acquired from its refrigerator storage area and submitted for examination. It is rare in that time for a significant acute neonatal/fetal problem not to be appropriately evaluated by placental examination with correlation of relevant histopathologic placental data.

    However, for neonates transferred from outlying hospitals to Texas Children’s NICU, fewer than 50% of placentas are recoverable for pathological examination. This delayed acquisition and evaluation of the properly stored but previously unexamined placenta brings to light a major deficit in many hospitals where placental pathology is performed: the absence of properly trained/interested placental pathologists. The tissue in both gross and histopathological examination is performed by a trained pathologist as a routine procedure. Typically, the pathologist is neither specially trained nor especially interested in the subject. In light of the potential medico-legal implications of pathological diagnosis, incorrect diagnoses often result in lawsuits that would not have occurred if the proper interpretation of the placenta had been made initially.

    To properly use our limited healthcare dollars, hospitals can do the following to acquire appropriate information for placentas that require examination:

    1. Acquire an appropriate number of refrigerators in the labor/delivery area and institute a 7-day hold-and-retain policy for all placentas not sent for initial examination. This policy must be made known to all medical, nursing, and delivery personnel.

    2. Review with appropriate neonatal, pathology, and obstetrical staff a list of indications for which placentas should be submitted with relevant, accurate, clinical (maternal/neonatal) data.

    3. Ensure that the pathology department has a skilled placental pathologist or that it refers placentas to an expert placental pathologist for review.

    The institution of these basic procedures will negate the need to examine all placentas at a cost of $0.5 billion to $1.1 billion annually. At 4.5 million placentas (multiples not counted) at charges of $750 for both hospital and professional charges, an approximately $3.375 billion price tag would attach.

    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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