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Pathologic Examination of the Placenta and Observed Practice

From the Departments of ¹Obstetrics & Gynecology and ²Pathology and Laboratory Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York.

OBJECTIVE: To estimate the percentage of deliveries eligible for pathologic examination of the placenta and compare with observed practice using the College of American Pathologists’ (CAP) 1997 guidelines for examination of the placenta.

METHODS: Records were reviewed from all live-birth deliveries 20 weeks or more of gestation in 2001 at Strong Memorial Hospital. The expected number of deliveries with CAP recommended indications was determined and compared with the observed number of deliveries in which the placenta was actually examined. Descriptive statistics, independent t tests, ² tests, difference between two population proportions test, odds ratios, 95% confidence intervals, and multiple logistic regression were used to analyze the data.

RESULTS: The observed number and percentage of deliveries with CAP recommended indications that had pathologic placental examination, 575 and 18.2% (95% confidence interval 16.9–19.6), was significantly lower (P<.001) than expected, 1,185 and 37.5% (95% confidence interval 35.8–39.2). The placenta was examined less frequently than expected in 9 of 14 categories. Independent predictors of examination of the placenta were gross placental abnormalities, multiple gestation, prematurity, peripartum fever, neonatal intensive care unit care of infant, cesarean delivery, and delivery by a maternal–fetal medicine specialist.

CONCLUSION: Using the CAP guidelines for submission of the placenta would result in pathologic examination in 37.5% of all deliveries. Less than one half of all deliveries in which the placenta was eligible for submission were actually examined. Current advances in our understanding of pathologic conditions of the placenta and their relation to infant outcomes may warrant reevaluating policy on placental examination at institutional and national levels.

LEVEL OF EVIDENCE: II