Pathologic examination of the placenta: recommended versus observed practice in a university hospital

Abstract

Amber Sills,1 Carmen Steigman,2 Songthip T Ounpraseuth,3 Imelda Odibo,1 Adam T Sandlin,1 Everett F Magann11Departments of Obstetrics and Gynecology, University of Arkansas for the Medical Sciences, Little Rock, AR, USA; 2Department of Pathology, University of Arkansas for the Medical Sciences, Little Rock, AR, USA; 3Department of Biostatistics, University of Arkansas for the Medical Sciences, Little Rock, AR, USAIntroduction: The purpose of this study was to determine the frequency of appropriate placental examinations in a university hospital.Methods: A retrospective review of all deliveries and all placentas submitted for pathologic examination from live births. Placentas were reviewed by a perinatal pathologist to determine whether they met the College of American Pathologists (CAP)-recommended guidelines for examination.Results: We used 1346 deliveries between July 1, 2010 and December 31, 2010 as the basis of this review. According to CAP guidelines, 703 placentas (52.2%) should have been sent for pathologic examination; 575/703 (81.8%; 95% confidence interval [CI] = 78.9–84.7) were actually sent for examination. Of the 643 placentas that did not need to be examined per CAP guidelines, 568 (88.3%; 95% CI = 85.9–90.8) were appropriately not sent. In comparing the three categories of indications for examination (maternal, fetal/neonatal, placental), the only significant association was that women with fetal/neonatal indications were more likely to have their placenta sent than women with maternal indications (odds ratio, 2.63; 95% CI = 1.81–3.80).Conclusion: In this university hospital, more than 80% of the time, placentas were appropriately sent to pathology, and more than 85% of the time, placentas that should not have been sent for evaluation were not sent.Keywords: placenta, pathologic examination, clinical guidelines, birth