PATHOLOGY EXAMS ARE VALUABLE
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 in our general 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 develop a process for the pathologic examination...including standardized
microscopic exams...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
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
In about 2010, the CDC stimulated neonatologists
to use antibiotics with babies born (1) under certain circumstances and/or (2) born to
mothers with certain situations. If pathology could execute a rapid microscopic exam to
diagnose or exclude a diagnosis of acute chorioamnionitis, then the baby could go home under
proper antibiotic therapy or with safe discontinuation of antibiotic therapy. With our
pathology group's prompt help, our hospital quickly adopted this standard.
Our pathology group has a website with
considerable placenta information [here].
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(posted 8/3/98; latest addition 31 July