Stillbirth continues to pose a significant public health challenge. Autopsy and placental assessments are recognized as the gold standard for stillbirth investigation. The utility of these procedures can vary based on the quality of the examination. The aim of this study is to determine the quality of placenta pathology reporting in Australia in the context of a stillbirth.
Materials and Methods:
Placenta pathology reports from stillbirths were reviewed from 18 maternity hospital from 2013 to 2018. The Khong tool was used to produce a placenta quality score (PQS), by a blinded panel of assessors to the cause of death. Outcome measures were the number of reports achieving the minimal acceptable score (MAS) of 75% or a poor score (PS) of 50% of the PQS.
Results:
560 placental pathology reports of which 494 were singleton and 66 were twin placentas. 282 (50%) achieved the MAS score. Macroscopic items were recorded well and microscopic items recorded poorly.
Conclusions:
The standard of placenta pathology reporting can be improved in Australia. The use of templates or checklists for both macroscopic descriptions and histological reporting is recommended to ensure all key components are described.
BlencoweHCalvert PhDCLawnJECousensSCampbellOM.Measuring maternal, foetal and neonatal mortality: challenges and solutions. Best Pract Res Clin Obstetr Gynaecol. 2016;36:14-29.
2.
AIHW. Stillbirths and Neonatal Deaths in Australia 2015 and 2016. AIHW; 2019.
3.
IGME UNICEF. A Neglected Tragedy: The Global Burden of Stillbirths. Fund UNCs, editor. IGME UNICEF; 2020.
4.
Australian Commission on Safety and Quality in Health. Stillbirth Clinical Care Standard. Australian Commission on Safety and Quality in Health; 2022.
MittalNByardRWDahlstromJE.A practical guide to placental examination for forensic pathologists. Forensic Sci Med Pathol. 2020;16(2):295-312.
7.
BentonSJLafreniereAJGrynspanDBainbridgeSA.A synoptic framework and future directions for placental pathology reporting. Placenta. 2019;77:46-57.
8.
GordijnSJDahlstromJEKhongTYEllwoodDA.Histopathological examination of the placenta: key issues for pathologists and obstetricians. Pathology. 2008;40(2):176-179.
9.
PSANZ. Perinatal Society of Australia and New Zealand Clinical Practice Guideline for Perinatal Mortality. PSANZ; 2012.
PSANZ. Perinatal Society of Australia and New Zealand Clinical Practice Guideline for Perinatal Mortality. V1.2. PSANZ; 2018.
12.
Faye-PetersenOMGuinnDAWenstromKD.Value of perinatal autopsy. Obstet Gynecol. 1999;94(6):915-920.
13.
PakisIKarapirliMKarayelFTuranAAkyildizEPolatO.Quality assessment of perinatal and infant postmortem examinations in Turkey. J Forensic Sci. 2008;53(5):1166-1168.
14.
MillerESMinturnLLinnRWeese-MayerDEErnstLM.Stillbirth evaluation: a stepwise assessment of placental pathology and autopsy. Am J Obstet Gynecol. 2016;214(1):115.e1-115.e6.
15.
SextonJKMahomedKMarsdenT, et al. Prospective cohort study: causes of stillbirth in Australia 2013-2018. Aust N Z J Obstetr Gynaecol. 2021;61(5):667-674.
16.
KhongTYGordijnSJ.Quality of placental pathology reports. Pediatr Dev Pathol. 2003;6(1):54-58.
17.
FlenadyVKingJCharlesA, et al. Clinical Practice Guideline for Perinatal Mortality Audit. PSANZ; 2009.
18.
LangstonCKaplanCMacphersonT, et al. Practice guideline for examination of the placenta: developed by the Placental Pathology Practice Guideline Development Task Force of the College of American Pathologists. Arch Pathol Lab Med. 1997;121(5):449-476.
19.
HargitaiBMartonTCoxPM.Best practice no 178. Examination of the human placenta. J Clin Pathol. 2004;57(8):785-792.
20.
PinarHKochMAHawkinsH, et al. The stillbirth collaborative research network postmortem examination protocol. Am J Perinatol. 2012;29(3):187-202.
21.
WeidaJNSchubertFPPastrickMAPatilAS.Comprehensive review of the stillborn placenta. J Midwifery Women’s Health. 2015;60(4):380-389.
22.
KhongTYMooneyEEArielI, et al. Sampling and definitions of placental lesions: Amsterdam Placental Workshop Group Consensus Statement. Arch Pathol Lab Med. 2016;140(7):698-713.
23.
TurowskiGParksWTArbuckleSJacobsenAFHeazellA.The structure and utility of the placental pathology report. Apmis. 2018;126(7):638-646.
24.
EvansCGoodingsLHargitaiB, et al. Tissue Pathway for Histopathological Examination of the Placenta. The Royal College of Pathologists; 2022.
25.
RobertsDJBaergenRNBoydTK, et al. Criteria for placental examination for obstetrical and neonatal providers. Am J Obstet Gynecol. 2023;228(5):497-508.e4.
PtacekISebireNJManJABrownbillPHeazellAE.Systematic review of placental pathology reported in association with stillbirth. Placenta. 2014;35(8):552-562.
28.
ValensteinPN.Formatting pathology reports: applying four design principles to improve communication and patient safety. Arch Pathol Lab Med. 2008;132(1):84-94.
29.
RenshawAAMena-AllaucaMGouldEWSirintrapunSJ.Synoptic reporting: evidence-based review and future directions. JCO Clin Cancer Inform. 2018;2:1-9.
30.
EllisDWSrigleyJ.Does standardised structured reporting contribute to quality in diagnostic pathology? The importance of evidence-based datasets. Virchows Arch. 2016;468(1):51-59.
31.
SunCCRevellVOBelliAJViscardiRM.Discrepancy in pathologic diagnosis of placental lesions. Arch Pathol Lab Med. 2002;126(6):706-709.
32.
RedlineRWVikTHeerema-McKenneyA, et al. Interobserver reliability for identifying specific patterns of placental injury as defined by the Amsterdam classification. Arch Pathol Lab Med. 2022;146(3):372-378.
33.
MarijnenMCBugelMIKhongTY, et al. Priority setting partnership on placental pathology: consensus recommendations for placental research. Placenta. 2025;160:67-72.
