Post-partum hemorrhage and malpractice claims: what can we learn from the findings of placental examination and endometrial curettage? A retrospective analysis of surgical pathology reports.
OBJECTIVE
This study reviews the surgical pathology reports of post-partum hemorrhages to support clinicians in malpractice litigation and, potentially, to enhance pregnancy-related diagnoses.


METHODS
This work is a retrospective study of surgical pathology reports of term pregnancies between January 2000 and January 2012 selected from the Surgical Pathology database of the I.R.C.C.S Azienda Ospedaliera Universitaria San Martino-IST (Istituto Nazionale per la Ricerca sul Cancro, Genoa).


RESULTS
Ninety-five revision reports were identified (0.22% "placenta accrete," 0.46% "non-accreta placental tissue retention," and 0.31% "no placental fragments retention"). Secondary post-partum hemorrhages occurred in 0.3%, and primary PPH occurred in 0.05%, regardless of the group examined. Both types of PPH were most often associated with vaginal deliveries (58%). The most frequent endometrial finding was post-partum endometritis (43%). The entire placenta was submitted to the pathologist in 22/95 cases (23%). Hypermaturity and/or villous immaturity were the main histological patterns.


CONCLUSIONS
This review supports the hypothesis that the pathological placenta abnormalities observed, rather than underlying myometrium abnormalities, may underlie the contractile failure and the incomplete removal of the placenta. For these reasons, the authors emphasized the importance of investigating the placenta in cases of complicated deliveries not associated with PPH to support clinicians in malpractice claims.
Forensic Institute, Rome, Italy.
Daniela
D
Marchetti
Valerio
V
Vellone
Ollga
O
Dhimitri
Ezio
E
Fulcheri
D000328:Adult; D002824:Chorionic Villi / Q000098:blood supply / Q000473:pathology; D003475:Curettage; D004716:Endometritis / Q000473:pathology; D005260:Female; D006801:Humans; D007511:Ischemia / Q000473:pathology; D007558:Italy; D008318:Malpractice / Q000331:legislation & jurisprudence; D008875:Middle Aged; D010920:Placenta / Q000473:pathology*; D010921:Placenta Accreta / Q000473:pathology; D018457:Placenta, Retained / Q000473:pathology; D006473:Postpartum Hemorrhage / Q000209:etiology*; D011247:Pregnancy; D012189:Retrospective Studies; D055815:Young Adult
malpractice claim; placenta; post-partum hemorrhage; surgical pathology