| | Recommended criteria based on the expert opinion of 16 placental pathologists and a pathologists' assistant, formulated using a modified Delphi approach[1] | Other suggested criteria* |
| Antepartum indications |
| Maternal indications | - Maternal death
- Systemic disease/disorders exclusive to:
- Diabetes, pregestational or poorly controlled gestational
- Infection potentially associated with fetal infection (eg, cytomegalovirus, syphilis, Zika virus, COVID-19)
- Metastatic cancer
- Severe hypertensive disorder (eg, chronic hypertension, gestational hypertension, preeclampsia with severe features, eclampsia, HELLP syndrome)
- Systemic autoimmune disease (eg, antiphospholipid antibody syndrome)
| - Alcohol use disorder, tobacco smoking, and substance use disorder (including use of medication for opioid use disorder [eg, methadone])
- Assisted reproductive therapies including gestational carrier pregnancies, gamete donor pregnancies, and in vitro fertilization
- Body mass index ≥40 kg/m2
- IUD in place
- Prior uterine surgery involving breach of the endometrium (eg, submucosal myomectomy, endometrial ablation) other than cesarean birth
- Systemic disease/disorders, including any of the following:
- Anemia requiring transfusions or with symptoms
- Cancer, any
- Cardiovascular compromise (any)
- Diabetes, any
- Hemoglobinopathy (eg, sickle cell disease or trait)
- Hypertension, any
- Thrombophilia
- Younger or older age (eg, <16 or >40 years)
|
| Obstetric indications | - History of a previous placental pathology known to recur (eg, abruption, chronic histiocytic intervillositis, massive perivillous fibrin deposition/maternal floor infarct, villitis of unknown etiology)
- Pregnancy loss
- Second- or third-trimester antenatal bleeding
| - Cervical insufficiency treated with cerclage
- Multiple gestation, any
- No prenatal care
- Oligohydramnios
- Postdates delivery (>42 0/7 weeks)
- Prolonged rupture of membranes (>24 hours)
- Vanishing twin
|
| Fetal indications | - Complications associated with multiple gestation (eg, twin-to-twin transfusion, selective growth restriction, twin anemia-polycythemia sequence, twin reversed arterial perfusion sequence, single fetal demise, conjoined twins)
- Fetal demise
- Fetal growth restriction
- Hydrops fetalis
- Severe fetal anomaly (eg, sirenomelia, congenital heart disease, renal agenesis, congenital pulmonary airway malformation, encephalocele, omphalocele, gastroschisis)
| - Abnormal genetic test results
- Anomalies, major; especially deformations and disruptions
|
| Intrapartum indications |
| | - Acute abruption
- Thick meconium in amniotic fluid
- Nonreassuring fetal heart rate tracing requiring urgent or emergency delivery
- Postpartum hemorrhage
- Preterm delivery (<37 weeks)
- Suspected chorioamnionitis
| - Extramural birth (eg, birth at home)
- Meconium-stained amniotic fluid, any
- Nonreassuring fetal heart rate tracing (eg, NICHD category II or III)
- Peripartum hysterectomy
- Precipitous birth
- Shoulder dystocia
- Umbilical cord prolapse
- Uterine rupture
|
| Neonatal indications |
| | - Anatomic anomaly, not detected prenatally
- Compromised clinical condition of the neonate at birth defined as any of the following:
- Apgar score of <7 at 5 minutes
- Cord blood pH <7
- Need for ventilatory assistance
- Neurological compromise (suspected hypoxic-ischemic encephalopathy)
- Persistent hypoglycemia (eg, requiring intravenous dextrose)
- Resuscitation >10 minutes
- Severe anemia (eg, hemoglobin <10 or 11 g/dL)
- Neonatal death
- Suspected malignancy
- Suspected meconium aspiration
- Suspected sepsis
| - Small or large for gestational age
|
| Placental indications |
| | - Retained placenta (to rule out placental accreta spectrum)
- Severe placental anomaly (eg, mass, massive fibrin deposition, discolored membranes, placenta membranacea)
| - Placental disorders (eg, placenta accreta spectrum, placenta previa, vasa previa)
- Unusual findings in any aspect of the placenta gross examination by an experienced examiner
|
| Other |
| | - Pregnancy termination for obstetric or maternal indications
| - Pregnancy termination for fetal indications
|
