Placental assessment: simple techniques to enhance best practice.
BACKGROUND
The placenta provides a 'diary' of the pregnancy. The information provided from pathological assessment of the placenta may provide important clinical information for both the mother and the neonate.


OBJECTIVE
To develop tools to ensure histopathological assessment of appropriate placentas and uniform provision of clinical history to pathologists to enable clinicopathological assessment.


METHODS
A placenta information form was devised that included the following clinical criteria: gestational age, prolonged rupture of membranes at term, suspected maternal/fetal bacterial or viral infection, swabs taken for culture, intrauterine growth restriction, perinatal death, pre-eclampsia, essential hypertension, diabetes, placenta praevia, multiple pregnancy and cytogenetics. A table was introduced into the midwifery placenta policy indicating clinical criteria for microbiology, histopathological or cytogenetic assessment. A colourful reminder poster was designed and placed in the delivery suite and education sessions were provided. Six-month review periods were performed prior to and following the two interventions.


RESULTS
The number of placentas submitted for histopathological examination (and meeting the inclusion criteria) increased from 41 (120/296) to 61% (161/266) following the initial interventions and to 82% (262/319) with the introduction of the reminder poster and education sessions. Clinically relevant placental pathology was found in 55 (64%) of cases in these time intervals. Comprehensive clinical history on the pathology report improved from 45 to 98% over the assessment time.


CONCLUSIONS
Valuable information on a pregnancy can be provided by ensuring histopathological examination of appropriate placentas with the simple introduction of placental information sheets, updated midwifery policy, education sessions and a colourful reminder poster.
Kent
Alison L
AL
Department of Neonatology, The Canberra Hospital, Australian National University Medical School, Australian Capital Territory, Australia. alison.kent@act.gov.au
Dahlstrom
Jane E
JE
D019985:Benchmarking / Q000592:standards; D003920:Diabetes Mellitus / Q000175:diagnosis; D005260:Female; D005313:Fetal Death / Q000175:diagnosis; D005317:Fetal Growth Retardation / Q000175:diagnosis; D005865:Gestational Age; D006801:Humans; D010920:Placenta / Q000473:pathology*; D010923:Placenta Previa / Q000175:diagnosis; D017410:Practice Guidelines as Topic; D011225:Pre-Eclampsia / Q000175:diagnosis; D011237:Predictive Value of Tests; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis* / Q000473:pathology; D011256:Pregnancy Outcome; D011272:Pregnancy, Multiple; D047928:Premature Birth / Q000175:diagnosis; D011446:Prospective Studies