While the placenta should always be examined grossly at the time of delivery, there are certain times that a complete pathologic examination should be performed.

Indication Group



systemic disorders with clinical concerns for mother or infant, including severe diabetes, impaired glucose metabolism, hypertensive disorders including toxemia, collagen vascular disease, seizures or severe anemia with hemoglobin < 9 g/dL


premature delivery <= 34 weeks gestation


prolonged pregnancy > 42 weeks


peripartum fever and/or infection


unexplained third-trimester bleeding or excessive bleeding > 500 mL


clinical concern for infection during pregnancy, including HIV, syphilis, CMV, primary HSV, toxoplasmosis, rubella


severe oligohydramnios


unexplained or recurrent maternal reproductive failure (intrauterine growth retardation, stillbirth, spontaneous abortion, premature birth)


invasive procedures with suspected placental injury, including amniocentesis, umbilical cord sampling, villus sampling, intrauterine transfusion




nonelective pregnancy termination


thick and/or viscid meconium


premature delivery from 34 to 37 weeks gestation


severe, unexplained polyhydramnios


history of maternal substance abuse


severe maternal trauma


prolonged rupture of membranes (> 24 hours)


HELLP (hemolysis, elevated liver function tests, low platelets)

Fetal or Neonatal

admission or transfer to other than a level 1 nursery


stillbirth or perinatal death


compromised clinical condition with any of the following: pH < 7.0, Apgar score <= 6 at 5 minutes, need for ventilatory assistance for more than 10 minutes, or severe anemia with hematocrit < 35%


hydrops fetalis (immune or nonimmune)


birthweight < 10th percentile


seizures or severe neurologic problems


infection or sepsis


major congenital anomalies, dysmorphic phenotype or abnormal phenotype


discordant twin growth with >20% weight difference


multiple gestation with same sex infants and fused placentas


birthweight > 95th percentile


asymmetric growth


multiple gestation without other indication


vanishing twin beyond the first trimester


physical abnormality such as infarct, mass, vascular thrombosis, retroplacental hematoma, amnion nodosum, abnormal coloration, opacification, malodor, placenta accreta, placenta previa


small or large placental size or weight for gestational age


umbilical cord lesion (thrombosis, torsion, true knot, single artery, absence of Wharton's jelly)


total umbilical cord length < 32 cm at term


abnormal placental shape


long umbilical cord (> 100 cm)


marginal or velamentous cord insertion


possible litigation



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