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Examination of the Placenta

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Pathology of the Human Placenta

Abstract

Most placentas are normal, as are most babies. Therefore, an examination of all placentas may not be warranted, although this has been advocated repeatedly. Practical guidelines, including indications for the examination, have been published by the College of American Pathologists (Langston et al. 1997). This reference describes in tabular form the major abnormalities and their association with clinical features. Booth et al. (1997) inquired what reasons constituted the submission of a placenta for examination and found, regrettably, that it was Cesarean section delivery. This is hardly a good reason, as will be seen. A large number of surgical deliveries are repeat sections and have little impact on perinatal problems for which placental examination might be useful. Altshuler and Hyde (1996), on the other hand, found that 92% of placentas for which an examination was requested by an obstetrician or neonatologist had relevant pathology. Salafia and Vintzileos (1990) made a strong plea for the study of all placentas by pathologists. We concur with this view, as the sporadic examination does not provide sufficient training for young pathologists and it does not allow the “routine” pathologist to obtain sufficient background knowledge as to what constitutes a truly normal placenta. Another reason for the examination of all placentas is today’s litigious climate; it makes study of placentas highly desirable (see Chap. 27). Furthermore, it has been shown repeatedly that a placental examination is needed to understand the causes of perinatal deaths. This was demonstrated, especially for stillbirths, by the study of Las Heras et al. (1994). The most important lesions were found in the umbilical cord (18%), with inflammatory lesions being second. Altshuler (1999) wrote a searching essay on the “placenta-related epidemiology” from his vast experience in these matters. Because placentas differ widely in shape, size, and in appearance, the novice must become familiar with this spectrum of placental shapes. To do so, a large number of placentas must be examined routinely. In hospitals with large numbers of deliveries, however, it may be prudent to select placentas for examination by the pathologist.

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Correspondence to Kurt Benirschke M.D. .

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Benirschke, K., Burton, G.J., Baergen, R.N. (2012). Examination of the Placenta. In: Pathology of the Human Placenta. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-23941-0_1

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  • DOI: https://doi.org/10.1007/978-3-642-23941-0_1

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