Placental pathology

[Enkidu]

---

Members don't see this ad.

What is the purpose of placental pathology? What sort of information are clinicians looking for when they submit placentas?

 

[Unty]

What is the purpose of placental pathology? What sort of information are clinicians looking for when they submit placentas?

You want to look for reasons why a baby may not be doing well...baby is in the NICU, has a fever, etc. One of the main things to look for is acute chorioamnionitis in the membranes or the chorionic plate. This can explain why the baby is not doing well.

Also, look for evidence of meconium laden macrophages as evidence of fetal distress. Fetus gets stress and starts pooping meconium. Meconium then gets into the amniotic fluid and then gets taken up by macrophages in the membranes, which you can see microscopically. The presence of meconium in macrophages can be important to document legally.

In the membranes in addition to meconium laden macrophages and acute chorioamnionitis, you want to look for decidual vasculopathy which are hypertension-related changes.

You want to look at the chorionic villi. Are they appropriate for gestational age?

There are certain conditions which can be associated with recurrent pregnancy loss such as chronic histiocytic intervillositis. Massive perivillous fibrin deposition which can be due to coagulation disorders or preeclampsia.

Also the umbilical cord is important as well. Make sure you dont miss Candida infection of the cord which can show up as very small tan yellow nodules on the cord surface. True knots can lead to fetal death.

If you have a twin pregnancy, look for evidence of twin twin transfusion syndrome (one baby is pale (donor) and the other baby is red and erythematous (recipient). This occurs in monochorionic (one disc) pregnancies because of anastomoses (both twins share the same blood supply via these anastomoses) in the placenta.

There are a lot of things you can find in the placenta, but what I mentioned are probably the most common stuff.

 

[Enkidu]

You want to look for reasons why a baby may not be doing well...baby is in the NICU, has a fever, etc. One of the main things to look for is acute chorioamnionitis in the membranes or the chorionic plate. This can explain why the baby is not doing well.

Also, look for evidence of meconium laden macrophages as evidence of fetal distress. Fetus gets stress and starts pooping meconium. Meconium then gets into the amniotic fluid and then gets taken up by macrophages in the membranes, which you can see microscopically. The presence of meconium in macrophages can be important to document legally.

In the membranes in addition to meconium laden macrophages and acute chorioamnionitis, you want to look for decidual vasculopathy which are hypertension-related changes.

You want to look at the chorionic villi. Are they appropriate for gestational age?

There are certain conditions which can be associated with recurrent pregnancy loss such as chronic histiocytic intervillositis. Massive perivillous fibrin deposition which can be due to coagulation disorders or preeclampsia.

Also the umbilical cord is important as well. Make sure you dont miss Candida infection of the cord which can show up as very small tan yellow nodules on the cord surface. True knots can lead to fetal death.

If you have a twin pregnancy, look for evidence of twin twin transfusion syndrome (one baby is pale (donor) and the other baby is red and erythematous (recipient). This occurs in monochorionic (one disc) pregnancies because of anastomoses (both twins share the same blood supply via these anastomoses) in the placenta.

There are a lot of things you can find in the placenta, but what I mentioned are probably the most common stuff.

This answer is awesome. Thread closed.

 

[deleted314957]

There are pathologists who are recognized as "expert" placental pathologists who make a living giving expert witness testimony in medmal cases re:bad baby/dead baby cases.

 

[TMZ2007]

In all seriousness, the things he mentioned above are just about all that's really clinically relevant about placental pathology. If you sign these things out with someone who is or thinks they are a placentologist, they'll point out all of this somewhat interesting, but totally unimportant stuff. Who cares? I mean, if you can document pathologically what they suspected clinically (chorio, twin-twin transfusion, CMV infection, etc.), that's super great. But if they've got a case of extended PROM, you think OB is waiting for the placenta report to come back "severe acute chorioamnionitis and funisitis"? I certainly hope not...

OTOH, The billing for placentas is favorable (CPT code 88307) and they are often totally free of gross and microscopic disease and can often be reduced to three total cassettes (anyone doing less than 3?) making net reimbursement/per unit of work and time very high indeed. The people in our department fight over placentas because they are easy RVUs...

 

[Circumflex]

As has already been mentioned, examination of the placenta can provide valuable information in trying to understand fetal demise (can have medico-legal implications)

 

[Unty]

There are pathologists who are recognized as "expert" placental pathologists who make a living giving expert witness testimony in medmal cases re:bad baby/dead baby cases.

Raymond Redline? Rebecca Baergen are the experts in placental pathology.

 

[pathstudent]

Lungs are to adult autops as placenta is to fetal autopsy.

 

[DrBloodmoney]

You want to look for reasons why a baby may not be doing well...baby is in the NICU, has a fever, etc. One of the main things to look for is acute chorioamnionitis in the membranes or the chorionic plate. This can explain why the baby is not doing well.

Also, look for evidence of meconium laden macrophages as evidence of fetal distress. Fetus gets stress and starts pooping meconium. Meconium then gets into the amniotic fluid and then gets taken up by macrophages in the membranes, which you can see microscopically. The presence of meconium in macrophages can be important to document legally.

In the membranes in addition to meconium laden macrophages and acute chorioamnionitis, you want to look for decidual vasculopathy which are hypertension-related changes.

You want to look at the chorionic villi. Are they appropriate for gestational age?

There are certain conditions which can be associated with recurrent pregnancy loss such as chronic histiocytic intervillositis. Massive perivillous fibrin deposition which can be due to coagulation disorders or preeclampsia.

Also the umbilical cord is important as well. Make sure you dont miss Candida infection of the cord which can show up as very small tan yellow nodules on the cord surface. True knots can lead to fetal death.

If you have a twin pregnancy, look for evidence of twin twin transfusion syndrome (one baby is pale (donor) and the other baby is red and erythematous (recipient). This occurs in monochorionic (one disc) pregnancies because of anastomoses (both twins share the same blood supply via these anastomoses) in the placenta.

There are a lot of things you can find in the placenta, but what I mentioned are probably the most common stuff.

This is a good answer. One thing I would highlight is to look for things that can effect future pregnancies (ie. always look at the maternal vessels, etc)

 

[Unty]

This is a good answer. One thing I would highlight is to look for things that can effect future pregnancies (ie. always look at the maternal vessels, etc)

Study ties Autism Risk to Creases in Placenta:

http://www.nytimes.com/2013/04/25/health/study-ties-autism-risk-to-creases-in-placenta.html

 

[malchik]

Whose brilliant idea was it to make placentas 88307 while bone marrow and kidney biopsies are 88305?

 

[KCShaw]

Probably more useful if the baby dies than if it survives, except for the medico-legal documentation aspect. As pointed out, the clinicians aren't waiting 24-48 hours to start treating a baby that isn't doing well, and babies who are doing well... are doing well, so it probably doesn't matter what you find, at least as far as common issues go. Of course there is a middle ground there where they don't start showing problems until later on, and as pointed out might occasionally have implications on fertility/survivability of other pregnancies. The real question is what the ratio is of placental examinations performed vs affecting current (as of the time of final report) or future treatment/pregnancy decisions.