ABSTRACT
In an ideal world, all specimens sent to pathology would have adequate clinical information to evaluate each case appropriately. Information about the pregnancy should be given, including the mothers age, parity, week of gestation, and any problematic issues relating to the prenatal course or course of labor, such as oligohydramnios or fetal compromise, any significant maternal diseases, diagnostic or therapeutic interventions on the fetus or placenta during the pregnancy, and any abnormalities of the fetus/ neonate. Information of significance includes history of trauma, substance abuse, sexually transmitted disease, pertinent maternal serological studies, signs and symptoms on admission (e.g. preterm labor, premature rupture of membranes with duration), peripartum complications such as infections, abnormalities of fetal heart rate tracings, pertinent ultrasound findings such as position, any anomalies, oligohydramnios or polyhydramnios, any infant karyotypic, structural or metabolic abnormalities, method of delivery, cord complications, total cord length if short, and vessel number. If premature separation was noted clinically, it should be described. This is particularly appreciable at cesarean section, where the percentage of placental separation can be assessed. Common obstetrical abbreviations and methods of fetal evaluation are listed in Tables 1-4. A variety of antepartum evaluations may have been performed to determine fetal wellbeing. Fetal movement assessment by the mother, contraction stress testing, which evaluates the fetal heart rate with contractions, non-stress testing, which evaluates the appropriate fetal heart acceleration with movement, uterine artery Doppler velocimetry, or fetal pulse oximetry may be employed. The biophysical profile described by Manning and colleagues11 is a non-stress test combined with an ultrasound scoring system of antenatal fetal wellbeing, with a maximum score of 10 for five parameters. A normal score is ≥8/10, with 6/10 equivocal, and 4 or less an abnormal score1. Placentas may be evaluated prior to delivery by ultrasound, and a grading system may be applied (grade III being a mature placenta), although no good correlation has been shown with fetal lung maturity12. The normal aging process of the placenta includes calcifications, on which the grading system is based. Increased calcification has also been noted in mothers who smoke cigarettes, or who have thrombotic orders and are under prophylactic therapy with aspirin or heparin12. At birth, the infant is also evaluated. The Apgar score, described by Virginia Apgar13 (Table 3), is assessed at 1 min, 5 min, and sometimes again at 10 min. The 1-min score is a good indicator of the need for immediate medical intervention, while the 5-min score is prognostic of the longer-term welfare of the infant, with a score greater than or equal to 7 being a good indicator of survival. Placentas that are sent for
pathological evaluation can be considered to fall into one of three categories: maternal issues, fetal issues, or placental issues (Table 5).
