Relationship of Underreporting of Placental Abnormalities to Clinical Diagnosis
FE Sharkey. University of Texas Health Science Center, San Antonio, TX
Background: A previous study of 100 cases of placental specimens showed a high rate of underdiagnosis of abnormalities in the final pathology report (Modern Pathology 1998;11:184A). This study sought to determine if the frequency of underreporting was influenced by the nature of the clinical diagnosis submitted with the specimen.
Design: The slides and diagnostic reports from a consecutive series of 100 placentas that were signed out by staff pathologists with no special training or experience in gynecologic pathology were examined retrospectively. Specimens had been submitted on the basis of specific clinical indications, and represented approximately 1/5th of all deliveries. For each case for which the clinical diagnosis indicated the potential for a pathologic abnormality that was evaluated in the study, the full report was reviewed to determine whether or not the clinical diagnosis was confirmed in the original pathologic diagnoses.
Results: A clinical diagnosis was submitted with 98 cases, and study parameters were appropriate to identify confirmation of the clinical diagnosis in 89 cases. Of these, pathologic abnormality related to the clinical diagnosis was present in 70 cases (79%), but the clinical diagnosis was correctly confirmed by the original pathologic diagnoses in only 41 of the 70 cases (59%), as follows (clinical diagnosis [no. confirmed/no. present; %confirmed]): Chorioamnionitis [12/12; 100%]; premature rupture of the membranes or maternal fever [2/2; 100%]; maternal diabetes [1/1; 100%]; twin gestation [5/6; 83%]; meconium [3/5; 60%]; pre-eclampsia [4/8; 50%]; fetal distress [3/6; 50%]; fetal anomalies [1/2; 50%]; abruption [2/5; 40%]; gross placental abnormality, NOS [2/5; 40%]; pre/post term gestation [5/13; 38%]; intrauterine growth retardation [1/5; 20%]. A confirmatory diagnosis was less likely to be missed if the clinical diagnosis (such as chorioamnionitis or abruption) was explicitly associated with a distinct pathologic finding than if the clinical diagnosis (such as fetal distress or pre-eclampsia) implied a pathologic finding less directly (73% vs. 46%; chi-square, p=0.02).
Conclusions: The frequency of underdiagnosis of placental abnormalities was significantly affected by the nature of the clinical diagnosis. Underdiagnosis of placental abnormalities may be reduced if pathologists become more aware of potential pathologic findings that are only implicitly associated with a clinical diagnosis.
Tuesday, March 10, 2009 1:00 PM
Poster Session IV # 152, Tuesday Afternoon