Indications for Pathologic Examination of the Placenta

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