While clinicians value placental pathology information, especially in cases where critical neonatal or maternal care is necessary, there are several barriers to a consistent, widely-used plan for sending a placenta to pathology after birth, according to new research published in PLOS One.
The Importance of Placental Pathology
The study authors conducted a qualitative survey of 19 maternal and neonatal clinicians from Penn State Milton S. Hershey Medical Center, Hersey, PA, to determine which pieces of information that can be ascertained from placental pathology are most relevant to postpartum care. Seven clinicians practiced maternal health, 9 were neonatal or pediatric clinicians, and 3 were family medicine providers who practiced both neonatal/pediatric and maternal medicine.
While maternal clinicians reported using information about the placenta for insight into clinical events and to provide guidance to the patient on future pregnancies, neonatal/pediatric clinicians reported using placental data to make immediate decisions about caring for the infant; specifically, antibiotic management.
Barriers to Widespread Use of Placental Pathology
Approximately half (n=10) of participants indicated they wanted to see a placental pathology report but it was not available to them. Eight of the participants (42%) were aware of a standard procedure for sending a placenta to pathology while the remaining 11 participants were either unaware or believed that there was no standard procedure (58%). Participant-reported estimates on how long it takes to receive a pathology report varied from 48 hours to 2 weeks.
The study authors found 4 main themes among participant interview responses:
- Placenta is sent for pathology but report is inconsistently accessed
- Pathology report is valuable for explanatory capability as well as contributing to care
- There is a need for rapid placental examination
- Pathology reports should be written in plain, understandable language.
The first theme, in which placentas were sent to pathology for consistent reasons but clinicians do not access the pathology reports consistently, had 3 subthemes: the report was difficult to find, difficult to understand, or did not come fast enough before the patient was discharged.
Clinicians indicated that the pathology report was sometimes difficult to find if the results were published on the mother’s chart but were necessary for pediatric care, or when the clinician who ordered the report at delivery is not the same clinician providing postpartum care.
Some participants felt that they were not adequately trained to interpret placental pathology reports; 8 participants stated that they frequently encounter unfamiliar terms in placental pathology reports and 5 participants stated they encounter unfamiliar terms at least sometimes. However, 4 participants reported that they never encountered unfamiliar terms.
The second main theme found that clinicians value placental pathology for explanatory capability as well as for contributions to current and future care. Common use cases for placental pathology include instances of growth restriction, infection, maternal preeclampsia, or in rare cases, fetal death.
“The placenta may in some instances factor into a decision about how long we continue antibiotic therapy,” said one participant. Similarly, another clinician explained that “The information can also be useful if we’re looking for causes for growth restriction. If the placenta can be a cause of it, we feel more comfortable in assigning that etiology to the growth restriction and don’t necessarily have to continue to worry about or track down metabolic or genetic disorders.”
The third main theme, that rapid placental evaluation would be helpful in providing clinical care, focuses on the immediate ways in which a placental pathology report could improve neonatal health outcomes.
Participants stated that the weight of the placenta, as well as any information about infection, can be particularly crucial in the first 24 hours as clinicians make decisions on whether to start antibiotics. Rapid placental pathology reports could help clinicians stratify a newborn’s risk and make informed decisions.
The fourth theme states that clinicians prefer placental pathology reports that connect clinically relevant findings and that are written with plain, standardized language, reducing the risk that clinicians will encounter unknown terminology.
The Future of Placental Pathology Reports
Artificial intelligence and machine learning make the future possibility of rapidly analyzing placentas for potentially clinically significant findings more realistic. Implementing standardized language and having a clear process for where reports are sent can help address barriers to proper use of placental pathology reports, concluded the authors.
Gallagher K, Aruma JC, Oji-Mmuo CN, et al. Placental pathology reports: A qualitative study in a US university hospital setting on perceived clinical utility and areas for improvement. PLoS One. 2023;18(6):e0286294. doi:10.1371/journal.pone.0286294