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Sep 21, 2004
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Hi folks! I am interested to hear how other programs handle placentas. At my program, the autopsy residents (there are 2 at a time) gross and sign out all the placentas sent to path. There can be a lot - probably 6-8/day. In theory, we have PA support, but this isn't really true in real life.

This is one of the major frustrations in my life right now, especially as I feel like I am stuck in a contest between autopsy attendings and placenta attendings. Just wondering what other programs are like in this respect.

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We have a dedicated rotation where placentas are dealt with.

During the rotation, the resident certainly does NOT gross in all placentas. We gross only twin placentas and placentas associated with IUFD or serious medical conditions (and no, chorio and IUGR is not included on that list). The majority of placentas are grossed in by a PA. This rotation is one of the easiest in our program.
Placentas were a part of OBGYN cases it is the responsibility of the resident OR PA on OBGYN
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at our program, the resident cutting for the day on surg path cuts in placentas, anywhere from 2-14/day. it gets to be a pain, but occasionally see something interesting-recently had a mesenchymal dysplasia.
We have three residents grossing every day, and the placentas are distributed between them. So, one resident probably does 1-3 a day. We get the placentas only if there was some sort of complication or if it was a multiple gestation. Apparently there is a fair amount of IVF going on here, as we do see a good number of multiples. I don't find grossing placentas to be all that edifying but don't mind it too much either. I was involved in a fetopsy case where the findings were really in the placenta -- it was useful to look at it at least in that case, as it did give some pretty strong supportive evidence for the presumed reason of fetal death (a maternal clotting disorder).
We only get placentas from deliveries that are somehow unusual. That usually works out to one or two per day, but I think I've had as many as five on a grossing day. It doesn't matter too much though, since our PA pretty much does all the placentas anyway. I think I've grossed in one placenta this year (the PA was at a conference).
Our PAs do most of the placentas, thank god. We have to do them on call on the weekends, when the PAs are off - could be 5 or 6 in a weekend if it's raining babies. So, not bad.
Whoever is assigned to grossing that day does everything including placentas. We usually average 2-5 daily. If your are on autopsy then you are on just autopsy.