Practice of Placenta Submission for Histopathological Examination, Experience of a Teaching/Tertiary Care Hospital in Saudi Arabia

Aljhdali, Hessa; Abdullah, Layla S.; Alhazmi, Dalia A; Almosallam, Ahmed M; Bondagji, Nabeel S.

doi:10.7759/cureus.17364

Cited by 4 publications

(5 citation statements)

References 19 publications

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“…The placenta is a diary of the pregnancy, and histopathological examination of the placenta can reveal valuable information with regard to the health of both the mother and fetus [ 20 ]. A myriad of placental histomorphological alterations had been implicated in maternal COVID-19 infection.…”

Section: Introductionmentioning

confidence: 99%

SARS-CoV-2 Infection in Pregnancy: Placental Histomorphological Patterns, Disease Severity and Perinatal Outcomes

Wong

Tan

Mustangin

et al. 2022

IJERPH

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The association between maternal COVID-19 infection, placental histomorphology and perinatal outcomes is uncertain. The published studies on how placental structure is affected after SARS-CoV-2 virus in COVID-19-infected pregnant women are lacking. We investigated the effects of maternal SARS-CoV-2 infection on placental histomorphology and pregnancy outcomes. A retrospective cohort study on 47 pregnant women with confirmed SARS-CoV-2 infection, matched with non-infected controls, was conducted. Relevant clinicopathological data and primary birth outcomes were recorded. Histomorphology and SARS-CoV-2 immunohistochemistry analyses of placental tissues were performed. Only 1 of 47 cases showed SARS-CoV-2 immunoreactivity in the syncytiotrophoblasts. Histologically, decidual vasculopathy (n = 22/47, p = 0.004), maternal vascular thrombosis (n = 9/47, p = 0.015) and chronic histiocytic intervillositis (n = 10/47, p = 0.027) were significantly higher in the COVID-19-infected placentas when compared to the control group. Maternal vascular thrombosis was a significant feature in the active COVID-19 group. A significant lower gestational age (p < 0.001)) at delivery and a higher caesarean section rate (p = 0.007) were observed in the active SARS-CoV-2-infected cases, resulting in a significant lower fetal-placental weight ratio (p = 0.022) and poorer Apgar score (p < 0.001). Notably, active (p = 0.027), symptomatic (p = 0.039), severe-critical (p = 0.002) maternal COVID-19 infection and placental inflammation (p = 0.011) were associated with an increased risk of preterm delivery. Altered placental villous maturation and severe-critical maternal COVID-19 infection were associated with an elevated risk of poor Apgar scores at birth (p = 0.018) and maternal mortality (p = 0.023), respectively.

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Section: Introductionmentioning

confidence: 99%

SARS-CoV-2 Infection in Pregnancy: Placental Histomorphological Patterns, Disease Severity and Perinatal Outcomes

Wong

Tan

Mustangin

et al. 2022

IJERPH

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“…This conclusion can be drawn by considering the falling number of placentas submitted to pathologic examination. For example, Aljhdali et al studied the practice of placenta submission for histopathological examination in a teaching/tertiary Hospital in Saudi Arabia; out of 8929 deliveries, 1444 (16.2%) placentas met the CAP guidelines, and only 583/1444 placentas (40.4%) were sent for pathologic examination [ 9 ]. Similar findings were reported in Aysha and Rafaat’s 2020 retrospective study in the United States, which indicated that 213 (42.6%) of 500 placentas should have been submitted for pathology evaluation, but only 135 (27% of the total) were submitted [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

“…Similar findings were reported in Aysha and Rafaat’s 2020 retrospective study in the United States, which indicated that 213 (42.6%) of 500 placentas should have been submitted for pathology evaluation, but only 135 (27% of the total) were submitted [ 10 ]. These studies and others showed a significant number of placentas that were not submitted for pathological studies, even though they met the CAP criteria [ 9 ]. These observations were the basis of our study which aimed to uncover the CAP guidelines understanding status among obstetricians of different training/experience levels who practice in different clinical settings.…”

Section: Discussionmentioning

confidence: 99%

“…This could be, in part, due to obstetrician’s unawareness of the indications for pathologic assessment of the placenta, as one survey of 111 obstetricians showed that more than 60% of the participants did not know about the CAP guidelines for placenta submission [ 6 ]. Financial pressures on the hospital were a cause in other instances [ 9 ]. Another possible reason for the dropping number of placenta submissions is the complexity of the reports and misunderstandings between placental pathologists and clinicians about the findings and value of a pathology report [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

“…Financial pressures on the hospital were a cause in other instances [ 9 ]. Another possible reason for the dropping number of placenta submissions is the complexity of the reports and misunderstandings between placental pathologists and clinicians about the findings and value of a pathology report [ 9 ]. A study showed that the reports are often misinterpreted by the obstetricians due to the nomenclatures used by the pathologists, which are unfamiliar to the obstetricians.…”

Section: Introductionmentioning

confidence: 99%

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Awareness of Placental Pathologic Examination Criteria and Utilization of Pathology Reports among Obstetricians

et al. 2023

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Background and Objectives: Several studies have reported a low rate of pathological examination of the placentas and a poor utilization of pathology reports. We assessed Saudi obstetricians’ awareness and utilization of the placental pathological examination guidelines of the College of American Pathologists (CAP) and evaluated their understanding of the reports. Materials and Methods: An anonymous survey was distributed to obstetricians registered in the Saudi Commission of Health Specialties database. We examined the association between the participants’ level of training or practice as well as their institution type with the surveyed elements. Results: Of 292 respondents, 34.2% were aware of the CAP guidelines. Most of them were practicing in government hospitals. Moreover, 18.2% of them routinely sent the placenta for pathological examination, and approximately 70.5% routinely reviewed the pathology reports and understood the nomenclature used; these percentages were significantly higher among university hospital practitioners. The residents were the least aware of the CAP guidelines and the least likely to review and understand the pathology reports. Regardless of the CAP guidelines awareness, the most common indication for placental pathologic examination was fetal anomalies, followed by medicolegal reasons and infections. Conclusions: Placental pathologic examination appeared uniformly underutilized in Saudi Arabia. Obstetricians are required to generate awareness of the need to comply with the CAP guidelines and to improve the understanding and utilization of pathology reports.

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Comparison of placental pathologies in pregnant women with COVID-19 according to disease severity

Farisoğulları

Sakcak

Kara

et al. 2023

Jinekoloji-Obstetrik Ve Neonatoloji Tıp Dergisi

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Aims: To evaluate the placental pathologies of pregnant women diagnosed with COVID-19 according to disease severity. Materials and method: This retrospective study was conducted at a tertiary center between April 2020 and February 2023. The placentas of 125 pregnant women in their third trimester who were positive for SARS-CoV-2 were examined. Placental pathologies were classified according to the modified Amsterdam criteria. According to the disease severity, the patients were divided into two groups: non-severe COVID-19 (n=104) and severe COVID-19 (n=21). Placental pathology results were compared between the two groups. Results: The rates of maternal vascular malperfusion (MVM) and fetal vascular malperfusion (FVM) were 90.4% and 45.2% in the non-severe COVID-19 group. Whereas it was significantly lower at 71.4% and 19% in the severe COVID-19 group (p=0.018 and p=0.026, respectively). The rate of delayed villous maturation (DVM) was 9.5% in the severe COVID-19 group and 1% in the non-severe COVID-19 group, indicating a statistically significant difference (p=0.019). Inflammatory pathologies and other pathological findings were similar between the two groups. Intensive care unit (ICU) admission, presence of accompanying maternal diseases, and postpartum complications were statistically significantly higher in the severe COVID-19 group (p

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Practice of Placenta Submission for Histopathological Examination, Experience of a Teaching/Tertiary Care Hospital in Saudi Arabia

Cited by 4 publications

References 19 publications

SARS-CoV-2 Infection in Pregnancy: Placental Histomorphological Patterns, Disease Severity and Perinatal Outcomes

SARS-CoV-2 Infection in Pregnancy: Placental Histomorphological Patterns, Disease Severity and Perinatal Outcomes

Awareness of Placental Pathologic Examination Criteria and Utilization of Pathology Reports among Obstetricians

Comparison of placental pathologies in pregnant women with COVID-19 according to disease severity

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