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Placental histopathology and its potential value to the neonatologist: a service evaluation

Presented at the Neonatal Society 2010 Summer Meeting (programme).

Dias RJ, Mat-Ali E

Neonatal Unit, Northwick Park Hospital, Harrow, HA1 3UJ, UK

Background: The placenta is an intergral part of the feto-maternal unit. Adverse conditions affecting the neonate may be noted in the placenta and this can be examined by a perinatal histopathologist. Placental histopathology is either underused or unavailable to some units. Placental examination may enlighten the neonatologist to the ongoing pathophysiology in the foetus or the neonate. It could provide significant information to assist in the immediate and later management of both the neonate and the mother (1). In cases of adverse neonatal outcomes it may help the neonatologist in the counselling of parents and the provision of medico-legal protection (1,2). We aimed to review placental histopathology reports along with corresponding clinical condition of the neonate looking for any association.

Aim: To determine if there is an association between placental histopathology and the clinical outcome of the neonate.

Methods: Placental histopathology reports were obtained from a tertiary perinatal centre for the year 2009. From these we randomly selected 30 reports for a pilot study. Corresponding maternal data, perinatal data and neonatal data were also gathered. Ethics approval not required. Based on patterns that we noted, we classified our results as outlined below.

1. Concordance: eg. Suspected sepsis in a sick neonate and ascending funisitis noted on histopathology.
2. Discordance: eg. Clinically well neonate but chorioamnionitis or funisitis found on histopathology.
3. Diagnostic (helpful in aiding diagnosis): eg. Profoundly unwell neonate, no maternal risk factors for sepsis but extensive ascending infection noted on histopathology.
4. Others: eg. Not of interest to the neonatologist, for instance intrauterine deaths or miscarriage.

Results: 319 placental histology reports were obtained for the year 2009. Of the 30 cases studied, 18 babies needed neonatal intervention, 10 babies did not require any neonatal intervention and 2 cases were intrauterine death or miscarriage. In 21 cases (70%), the placental histopathology report showed concordance with the clinical suspicion. In 3 cases (10%) the placental histopathology was diagnostic. In 4 cases (13.3%), the placental histology showed discordance. In 2 cases (6.7%), the reports were grouped as others (IUD or miscarriage).

In the Discordance Group there were 3 histopathology reports with evidence of ascending infection and 1 case of haemorrhage but the neonates were all well. The Diagnostic Group included 3 cases of unexplained poor outcomes to pregnancy where significant abnormalities were noted on histopathology. Significant abnormalities in the umbilical cord (e.g. velamentous insertion, funisitis, necrosis) and abnormalities in the placenta both on macroscopic (e.g. circumvallate placenta, placental bleeding) and microscopic (e.g. chorioamnionitis, decidual infarcts) examination were noted.

Conclusion: Placental histopathology is a useful tool particularly when there is a poor outcome to pregnancy. We were able to categorise these reports and show a clinical significance. This may be used as a tool by the neonatologist to guide management of the sick neonate and help in the counselling of parents particularly when the placental findings aided in the neonatal diagnosis. These reports may also help with medicolegal aspects in cases of severe morbidity or mortality. The results from this pilot study are encouraging and we would like to complete this case series to substantiate our findings.

1. Yetter J, Examination of the placenta, American Academy of Physicians 1998, March.
2. Chang KTE, Pathological examination of the placenta, Singapore Medical Journal 2009, 50(12):1123.

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