Criteria for placental examination for obstetrical and neonatal providers

被引：21

作者：

Roberts, Drucilla J. ^{[1
,2
]}

Baergen, Rebecca N. ^{[3
]}

Boyd, Theonia K. ^{[4
]}

Carreon, Chrystalle Katte ^{[2
,5
]}

Duncan, Virginia E. ^{[6
]}

Ernst, Linda M. ^{[7
]}

Faye-Petersen, Ona M. ^{[8
,9
]}

Folkins, Ann K. ^{[10
,11
]}

Hecht, Jonathon L. ^{[2
,12
]}

Heerema-McKenney, Amy ^{[13
]}

Heller, Debra S. ^{[14
]}

Linn, Rebecca L. ^{[15
]}

Polizzano, Carolyn ^{[16
]}

Ravishankar, Sanjita ^{[17
,18
]}

Redline, Raymond W. ^{[19
,20
,21
]}

Salafia, Carolyn M. ^{[22
]}

Torous, Vanda F. ^{[1
,2
]}

Castro, Eumenia C. ^{[23
,24
]}

机构：

[1] Massachusetts Gen Hosp, Dept Pathol, Boston, MA 02114 USA

[2] Harvard Med Sch, Boston, MA 02115 USA

[3] Weill Cornell Med, Dept Pathol & Lab Med, New York, NY USA

[4] Texas Childrens Hosp, Dept Pathol, Houston, TX USA

[5] Bostons Childrens Hosp, Dept Pathol, Boston, MA USA

[6] Univ Alabama Birmingham, Dept Pathol, Div Womens Hlth, Birmingham, AL USA

[7] NorthShore Univ Hlth Syst, Dept Pathol, Evanston, IL USA

[8] Univ Alabama Birmingham, Heersink Sch Med, Dept Pathol, Birmingham, AL USA

[9] Univ Alabama Birmingham, Heersink Sch Med, Dept Obstet & Gynecol, Birmingham, AL USA

[10] Stanford Healthcare, Dept Pathol, Stanford, CA USA

[11] Stanford Univ, Stanford, CA USA

[12] Beth Israel Deaconess Med Ctr, Boston, MA USA

[13] Cleveland Clin, Cleveland, OH USA

[14] Rutgers New Jersey Med Sch, Newark, NJ USA

[15] Childrens Hosp Philadelphia, Dept Pathol, Philadelphia, PA USA

[16] MidState Med Ctr Dept Pathol, Meriden, CT USA

[17] Case Western Reserve Univ, Sch Med, Cleveland, OH USA

[18] Univ Hosp Cleveland Med Ctr, Dept Pathol, Cleveland, OH USA

[19] Case Western Reserve Univ, Sch Med, Dept Pathol, Cleveland, OH USA

[20] Case Western Reserve Univ, Sch Med, Dept Reprod Biol, Cleveland, OH USA

[21] Univ Hosp Cleveland Med Ctr, Cleveland, OH USA

[22] Placental Analyt LLC, New Rochelle, NY USA

[23] Texas Childrens Hosp, Houston, TX USA

[24] Baylor Coll Med, Dept Pathol, Houston, TX USA

来源：

AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY | 2023年 / 228卷 / 05期

关键词：

critical values in placental pathology; guidelines for placental pathologic examination; indications for placental examination; placental diseases; placental gross examination; placental handling; placental pathology; placental triage; UMBILICAL-CORD ULCERATION; PLATE MYOMETRIAL FIBERS; PATHOLOGICAL ASSESSMENT; VASCULAR MALPERFUSION; DEVELOPMENTAL ORIGINS; INTESTINAL ATRESIA; MECONIUM PASSAGE; CEREBRAL-PALSY; BLOOD-PRESSURE; BIRTH;

D O I：

10.1016/j.ajog.2022.12.017

中图分类号：

R71 [妇产科学];

学科分类号：

100211 ;

摘要：

Pathologic examination of the placenta can provide insight into likely (and unlikely) causes of antepartum and intrapartum events, diagnoses with urgent clinical relevance, prognostic information for mother and infant, support for practice evaluation and improvement, and insight into advancing the sciences of obstetrics and neonatology. Although it is true that not all placentas require pathologic examination (although alternative opinions have been expressed), prioritization of placentas for pathologic examination should be based on vetted indications such as maternal comorbidities or pregnancy complications in which placental pathology is thought to be useful for maternal or infant care, understanding pathophysiology, or practice modifications. Herein we provide placental triage criteria for the obstetrical and neonatal provider based on publications and expert opinion of 16 placental pathologists and a pathologists' assistant, formulated using a modified Delphi approach. These criteria include indications in which placental pathology has clinical relevance, such as pregnancy loss, maternal infection, suspected abruption, fetal growth restriction, preterm birth, nonreassuring fetal heart testing requiring urgent delivery, preeclampsia with severe features, or neonates with early evidence of multiorgan system failure including neurologic compromise. We encourage a focused gross examination by the provider or an attendant at delivery for all placentas and provide guidance for this examination. We recommend that any placenta that is abnormal on gross examination undergo a complete pathology examination. In addition, we suggest practice criteria for placental pathology services, including a list of critical values to be used by the relevant provider. We hope that these sets of triage indications, criteria, and practice suggestions will facilitate appropriate submission of placentas for pathologic examination and improve its relevance to clinical care.

引用

页码：497 / +

页数：16

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