Domenici et al developed a score for grading changes in a placenta and correlating these with the severity of the neonate's withdrawal reaction. This can help to identify a neonate who may experience more severe and prolonged symptoms. The authors are from University of Pisa in Italy.
Placenta selection: from a neonate whose mother abused drugs during the pregnancy
Parameters:
(1) signs of chronic hypoxia in the chorionic disc
(2) retroplacental hematoma
(3) depressed areas on the maternal side of the maternal disc (basal plate)
(4) acute infection (chorioamnionitis, villitis, funisitis)
(5) signs of intrauterine subacute distress
|
Parameter |
Finding |
Points |
|
signs of chronic hypoxia |
absent |
0 |
|
|
mild |
1 |
|
|
moderate |
2 |
|
|
severe |
3 |
|
retroplacental hematoma |
absent |
0 |
|
|
mild |
1 |
|
|
moderate |
2 |
|
|
severe |
3 |
|
depressed areas |
absent |
0 |
|
|
mild |
1 |
|
|
moderate |
2 |
|
|
severe |
3 |
|
acute infection |
absent |
0 |
|
|
mild |
1 |
|
|
moderate |
2 |
|
|
severe |
3 |
|
signs of intrauterine subacute distress |
absent |
0 |
|
|
mild |
1 |
|
|
moderate |
2 |
|
|
severe |
3 |
where:
• Signs of chronic hypoxia in the chorionic disc includes: infarcts, inappropriate maturation of chorionic villi, inappropriate vascularization of the chorionic villi, abnormal fibrin deposits, perivillous fibrin, fibrinoid necrosis, marginal sclerosis of the maternal surface, intraparenchymal hematoma.
placental score =
= SUM(points for all 5 parameters)
Interpretation:
• minimum score: 0
• maximum score: 15
• A score >= 3 was associated with more severe withdrawal reactions.
Specialty: Toxicology, Emergency Medicine, Critical Care
