Examination of the placenta/placental pathology

• This SOP is intended to standardise the procedure for examining the placenta and membranes after birth.
• Retained products of conception are one of the main causes of postpartum haemorrhage and infection.

NHS Borders is committed to the provision of a service that is fair, accessible and meets the needs of all individuals.

Examination of the placenta should take place as soon as possible after delivery in a well lit area, staff must use appropriate PPE.

• examine the cord, count the vessels in the cord and observe for the presence of true knots or thrombi
• separate the amnion from the chorion to ensure both are present
• ensure all cotyledons are present

Findings should be clearly documented on Badgernet – if there are concerns about completeness of a placenta it is important to inform the woman to be observant for an increase in blood loss/passing clots or signs of infection.

A placental swab should be obtained in the following instances:

• maternal sepsis
• offensive smelling liquor
• suspected chorioamnionitis
• baby born in unexpectedly poor condition
• in all cases of IUD

Ensure all specimens are correctly labelled and the examination of placenta form is completed.

• stillbirth (antepartum or intrapartum)
• miscarriage (14+0–23+6 completed weeks’ gestation)
• severe fetal distress defined as: pH 4.8mmol/l
• preterm birth (less than 32+0 weeks’ gestation)
• fetal growth restriction defined as: birthweight below 3rd centile or drop in fetal growth velocity of >2 quartiles or >50 percentiles
• abnormal umbilical artery Dopplers (absent or reversed end diastolic flow)
• fetal hydrops

Early onsent (<32 weeks) severe preeclampsia requiring iatrogenic early delivery
caesarean peripartum hysterectomy for morbidly adherent placenta
severe maternal sepsis requiring adult intensive care admission and/or fetal sepsis requiring ventilation or level 3 NICU admission (following swab taken from the placenta for microbiology at delivery)

• massive placental abruption with retroplacental clot
• monochorionic twins with TTTS.

Referral is not indicated in the following conditions as histopathological examination is unlikely to provide useful information:

• cholestasis of pregnancy
• ‘gritty’ placenta
• pruritis of pregnancy
• maternal diabetes with normal pregnancy outcome
• hepatitis B, HIV, etc
• other maternal disease with normal pregnancy outcome
• placenta praevia • post-partum haemorrhage
• polyhydramnios • rhesus negative mother with no fetal hydrops
• history of maternal Group B streptococcus
• maternal coagulopathy
• maternal substance abuse
• uncomplicated twin pregnancy
• congenital anomaly
• common aneuploidies
• low grade pyrexia in labour
• history of previous molar pregnancy

NB: To ensure a placenta is not disposed of too quickly please retain in the clean sluice in a sealed yellow bag, in the yellow placenta box (do not seal the lid), labeled with the patient’s addressograph. After 1 hour the placenta can be disposed of as normal.

• The majority of women will want the midwife to dispose of the placenta which should be done in accordance with NHS Borders policy.
• The placenta should be placed in a yellow placenta bag then into a placenta pot and placed into a yellow waste bag.
• If a woman wishes to take her placenta home double bag the placenta and place it in a white tub for transport home.