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Placentas

The placental request form can be ordered directly from Medical Illustration at GRI (for NHSGGC users) Order code MIS260726. Non NHSGGC users should contact the department who will supply a high quality PDF file by e-mail.

Listed below are the data items that are required for pathological examination of placentas. Essential and Required data items are in bold and the remainder should be added as required. Please include these data items on the pathology request form accompanying the placentas.

Please write clearly on the forms

  • Mother’s name
  • Mother’s date of birth
  • Address
  • Hospital Number and CHI number
  • Date of delivery
  • Date placenta sent for pathology examination
  • Referring Hospital
  • Referring consultant
  • Midwife or trainee doctor’s name and contact extension / bleep number
  • Gravida and Parity
  • Gestation
  • Apgars of the baby / babies delivered
  • Weight of the baby / babies delivered

 

In cases of stillbirth / late miscarriage, please provide the following information if possible:

  • Foot length
  • Body weight
  • Presence or absence of maceration
  • Colour of foetus
  • Statement as to whether the foetus is structurally normal. 

 

IUGR: (Intrauterine growth restriction)

MATERNAL PYREXIA

LIQUOR: Polyhydramnios/anhydramnios/meconium staining

PRE-ECLAMPSIA/ECLAMPSIA

MEMBRANES: PPROM/PROM/SROM

DIABETES

ANTEPARTUM HAEMORRHAGE

OTHER THROMBOPHILIA

FOETAL DISTRESS

MATERNAL HISTORY

DELIVERY: spontaneous/induced, vaginal/forceps/ventouse/section

ASSISTED CONCEPTION (Clomiphene, IUI, IVF, ICSI etc.)

PRESENTATION: vertex, breech/cord compression/cord prolapse

CERVICAL INCOMPETENCE

INFECTION RISK: Cat 3 organisms or TORCH

THYROID DISEASE

GENETICS: Amniocentesis/CVS/amnion

OTHER MEDICAL CONDITIONS/DRUG HISTORY: e.g. Lupus

AFP (normal, low, high)

PLACENTATION: Placenta previa/placental abruption/placenta accrete (including increta and percreta) etc.

ULTRASOUND SCAN RESULTS

HIGH VAGINAL SWAB: Has it been taken for microbiology/virology?

DYSMORPHISM of the baby

FETAL DEMISE/PERINATAL DEMISE: If the baby/foetus died when was the last evidence of life? Has a post mortem examination been requested?

 

Levels of Placental Examination Based on Clinical Indication

The Pathology Department carries out 4 types of placental examination, based on the provided clinical information and indication for placental examination:

 

1. Full Examination with Histology

These placentas will be examined macroscopically and have blocks will be taken for histology. A full report will be issued after the histology is reported.

 

Proposed indications for full examination with histology are:

  • Stillbirth
  • Late Miscarriage
  • Neonatal Death
  • Preterm Delivery with Gestation of 31+6/40 and below
  • Foetal Growth Restriction (birth weight below 10th centile)/>25% discrepancy in twin pregnancy
  • Triploidy/Molar Pregnancy (current pregnancy only)
  • Hydrops
  • Morbidly Adherent Placenta
  • Unexpected Neonatal Unit admission with cord pH<7.1 or Apgar <7 at 5 mins.
  • Triplets/Complicated twin pregnancy (with one of the above complications)
  • Consultant obstetrician request (pending triage by pathology consultant)

2. Macroscopic Examination without Histology

These placentas will have a macroscopic report issued shortly after the placenta is examined macroscopically (generally within a fortnight). Blocks will be taken for histology, should this be requested. The placenta will be retained for 3 months in the pathology department prior to disposal. Histology will only be performed on request.

 

Proposed indication for macroscopic examination without histology: 

 

  • Abruption
  • Severe pre-eclampsia

 

While not indicated for placental examination, macroscopic examination can be used to verify macroscopic abnormalities such as abnormal placental shape or single umbilical artery.

 

3. Macroscopic Examination for Chorionicity Only – Twin Placentas

Placentas from multiple births are not always indicated for placental examination.

 

Placentas from complicated twin pregnancies may be sent for full examination.

 

Placentas from uncomplicated same sex twin pregnancies may be sent for examination of chorionicity only. A brief report detailing chorionicity only will be issued shortly after the placenta is examined (generally within a fortnight). The placentas will be retained for 3 months in the pathology department prior to disposal. Full macroscopic examination with histology will only be performed on request.

 

Proposed indication for macroscopic examination for chorionicity only:

 

  • Same sex twins - chorionicity only

 

4. Storage Only

These placentas are not indicated for placental examination by our local protocol and do not need to be sent for pathology. If sent to pathology, they will be stored with no initial examination. A brief report indicating the placenta has been stored will be issued shortly after the placenta is received (generally within a fortnight). These placentas will be retained for 3 months in the pathology department prior to disposal. Full macroscopic examination with histology will only be performed on request.

 

This would be performed for any placentas that do not fall into the placental indications listed above, including:

 

  • Preterm delivery with gestation of 32/40 and above
  • Foetal distress NOS or with Apgar of 7 or more at 5 minutes or with cord pH >7.1
  • Neonatal Unit admission NOS
  • Expected/explained admission to neonatal unit i.e. foetal anomaly, preterm 32-36/40/
  • Maternal pyrexia/sepsis/ascending infection
  • Different sex twins – uncomplicated pregnancy
  • Previous molar pregnancy
  • Foetal anomaly
  • Rhesus iso-immunisation
  • Coagulopathy
  • Substance abuse
  • PROM > 36 hours
  • Gestational diabetes
  • Rh – Mother
  • Group B Strep
  • Cholestasis
  • Pruritus
  • HBV/HIV
  • Placenta previa
  • PPH
  • Polyhydramnios
  • TOP for Trisomy 13, 18 or 21/Turners/Foetal Anomaly
  • Known Trisomy 13, 18 or 21/Turners
Last Updated: 12 March 2021