Placenta Submissions: Are the Appropriate Indications Being Met?
Kathryn P Whelan, Reza Alaghehbandan, Beverly Carter, Stephen Raab. Eastern Health, St. John's, NL, Canada
Background: Obstetric services informally and formally use clinical indicators to determine a practice of placental submission for pathologic examination. In cost-contained systems, clinical indicator triage algorithms balance patient safety (appropriate diagnosis) with efficiency and may be used to assess the appropriateness of submission practices.
Design: We performed a one-year retrospective medical record review of all submitted placentas (n = 600) to determine if the obstetrical clinical history contained appropriate indicators for placental submission for pathologic examination. We selected a random sample of 119 placentas and recorded if a clinical indicator was provided. If an indicator was present, we classified the indicator into one of three categories: maternal, fetal, and placental. Each of these indicators consisted of 3 or 4 conditions (e.g., fetal indicators: fetal compromise, fetal phenotype abnormality, or multiple gestations). We determined the level of concordance between clinical indicator condition and placental pathologic diagnosis.
Results: Of submitted placentas with clinical indicators (81%), 49% were maternal indicators, 31% fetal, and 19% placental. In 64% of placentas, the pathologic diagnosis correlated with the clinical indicator. The highest concordance (100%) was with the suspected condition of chorioamnionitis/infection and the lowest level of concordance (33%) was with suspected placental conditions (e.g., previa, retained products, etc.). In 19% of specimens, an appropriate clinical indicator was not provided and the majority was from women who had a Cesarean section with bilateral tubal ligation and no maternal, fetal or placental indications of disease. None of these placental specimens had significant pathologic findings. Extrapolated to the entire year, our laboratory performed a placental examination without appropriate clinical indication in 114 cases.
Conclusions: We hypothesize that a standard clinical indicator checklist may be used to triage placentas for pathologic examination. Providing clinicians with correlation of clinical indicator-pathologic findings also may be used to evaluate the utility of the clinical indicator assessment. Improved lab efficiency may be achieved by limiting unnecessary placental examinations without compromising safety.
Category: Quality Assurance
Monday, March 19, 2012 9:30 AM
Poster Session I Stowell-Orbison/Surgical Pathology/Autopsy Awards Poster Session # 309, Monday Morning