We have followed the evolution of the importance of placenta pathology exams since 1978. Pathology residency training programs prior to that time gave practically no teaching on placental pathology. Most hospitals froze the placentas for reagent companies ( a sort of primitive form of recycling...before the days of recycling out in society).

A nationwide consensus conference of all specialties having anything to do with births and placentas was convened in Atlanta in 1990 (attended by our Drs. Shaw & Carter). Recommendations were drafted. The coverage for placenta exams had already been forefront at Lexington Medical Center, a hospital which already had Women's Hospital of Lexington.

Our pathology group was challenged by several obstetricians to developed a process for the pathologic...including standardized microscopic exams...examination of every placenta from every delivery.

In a 4 month period of 1994, 677 placentas were so examined, only 104 having been "doctor-ordered" (15%). At no financial charge to the patient, 573 were examined without a doctor's order.

Of the 573 (which would have here-to-fore been disposed of), 48 (8%) had unmistakable, unequivocal evidence of bacterial infection. Maternal records review indicated that 26 of the cases (54%) were from pregnancies and labor and delivery which appeared to be normal (except that 18 failed to progress in labor on their own.... 9 having labor augmented and 9 have C-section). Therefore, 8 were entirely normal. It had been previously presumed that placentas from nearly-normal-to-normal pregnancies were always normal.

The doctors felt that the exam of all placentas was problematic because: (1) the abnormalities were often probably clinically trivial; (2) the expense of the pathology exam would unwarrantedly add to the overall cost of medical care; and, (3) there was no standard knowledge base from which to explain to the mother about the wide variety of findings in "abnormal" placentas in apparently normal pregnancies. A few doctors had faced hysterical responses from mothers who were frightened by the "diagnoses of uncertain significance". So, the all-placentas-pathology-exam program was discontinued. We perform exams only on those cases sent to pathology by the doctor's order. We then perform a good-faith complete exam especially to rule out occult abnormalities which could be overlooked because (1) everyone's attention was on an obvious problem such as a retroplacental clot or (2) that important abnormality was not interpretable...or even visible...to the naked eye. [a case]

Ironically, the federal government was, at that very time, creating Pap smear regulations that would create whole categories of "atypical cells of uncertain significance" which would drive all of us doctors crazy for at least half of a decade...because no one could properly & consistently explain the significance to every female patient!

Our pathology group has a website with considerable placenta information [here].

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