Why is the placenta being ignored?

The relationship between the frequency of published recommended indications for placental pathological examination and the frequency of requests for s uch examination in a population-based study of term newborn encephalopathy was examined. Only 11.2% of placentas among 276 case infants and 0.7% of pl acentas among 564 term control infants were examined. Using the criteria se t out in a consensus statement by the American College of Pathologists, all 276 cases fulfilled multiple maternal, fetal and placental indications for placental examination. Furthermore 43.3% of control infants fulfilled at l east one criterion. Of the 25 case placentas that underwent pathological re view, 16 were reported as having no diagnostic abnormality Six cases (24%) showed clinically important findings: four had evidence of infection, one h ad multiple chorangiomata and one had thrombosis and rupture of the umbilic al vein. Of the three remaining placentas, one showed funisitis, one showed minor lymphohistiocytic villitis and one was from monochorionic twins. To our knowledge there are no agreed Australian guidelines for when a placenta should be submitted for pathological examination. We suggest that until gu idelines based on properly designed studies are developed it may be appropr iate to store all placentas for at least 72 hours. If the infant develops n eurological symptoms or requires unexpected admission to a neonatal intensi ve care unit then placental examination may reveal important aetiological d iagnostic and prognostic information.