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 |
Condition |
Maternal |
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 |
|
abruption |
|
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 |
Placental |
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 |
Other |
possible litigation |
Specialty: Obstetrics & Gynecology