What is Perinatal Pathology?
Perinatal Pathology is the study of diseases of the placenta, fetus and neonate.
The perinatal period is classically defined as the time immediately before and after birth. Different time cut-offs have been used but typically the perinatal period is from 28 weeks gestation to 4 weeks after birth. Many perinatal pathologists are experts in diseases throughout the gestational period and into the neonatal period.
Perinatal pathologists examine the tissues of pregnancy, including the placenta, embryo and fetal tissue. When a neonatal death occurs, a perinatal pathologist is well-equipped to perform the autopsy.
Placentas are sent to pathology for examination based on various indications which include problems in the pregnancy such as hypertension, infection, and diabetes. A perinatal pathologist is typically an expert in diseases of the placenta and works with obstetricians to understand poor pregnancy outcomes in their patients. Placental pathology can also inform neonatal care in specific circumstances such as infection, neurologic injury/encephalopathy or hematologic abnormalities.
Fetal and embryo tissue is examined by a perinatal pathologist when there has been a pregnancy loss. Perinatal pathologists typically perform a thorough examination of the tissues to potentially determine the cause for the pregnancy loss. Depending on state laws, these examinations may be called surgical pathology examinations or autopsies.
The perinatal pathologist reviews cases of in-utero fetal demise or demise in the neonatal period, or terminations due to fetal abnormality or pregnancy complication. The goal is to establish the specific cause of death or complication, and risk of recurrence in subsequent pregnancies.
Diagnosis is often a collaborative effort, so tissue may be taken for ancillary testing including genetics, microbiology and x-rays; and case discussions with pediatric surgeons, obstetricians, and geneticists are sometimes the most intellectually rewarding part of the job. We are also consultants to our general pathologist colleagues in the community. Because there are so few of us, we have an important role in teaching and quality assurance; a key function of SPP and this committee is to promote standardized diagnostic terminology.
Perinatal pathologists are typically board certified in Pathology (either Anatomic Pathology and Clinical Pathology or both) and most perinatal pathologists have specialized training in either gynecologic and/or Pediatric pathology. Pediatric Pathology is a board-certified subspecialty in Pathology, and it has long been recognized that Perinatal Pathology is part of training in Pediatric Pathology. The board certification examinations in Pediatric Pathology reflect the need for knowledge in perinatal pathology.
Academic pathology department in a suburban hospital with high risk obstetrical and neonatal services.
- Early morning in my office: sign out of placentas grossed by our PA’s (6-8 cases).
- 9:00 a.m. - down to autopsy suite to begin fetal autopsy dissection with first year resident
- 11:00 a.m. break for seminar - visiting professor.
- Finish up autopsy and work on PAD with resident; sign out PAD
- Afternoon in my office:
- Deal with sign out of all POCs - today there are 4- all have problems!
- Review slides from a pending autopsy with a resident
- Discuss the final report with her and then communicate with clinicians about results because they inquired about results yesterday.
- Sign out some more placentas focusing on the ones from infants admitted to intensive care to expedite the reports.
- I also do adult autopsy so I began review of the slides from a case previewed by a resident before calling it a day.
The Perinatal Section, composed of those members of the SPP with an interest and expertise in perinatal pathology, makes recommendations to the Board of Directors of the SPP regarding perinatal interests and proposed activities. This includes:
- Coordinating the annual Perinatal Symposium at the Fall meeting to work with the local perinatal symposium organizer as to speakers and content.
- Monitoring the educational content of the Perinatal Symposium and make recommendations.
- Conducting an annual Perinatal Group business meeting to solicit input from the Perinatal Group.
- Coordinating the Perinatal Slide Symposium (not for CME) for the Fall Meeting.
- Overseeing planning of the intermittent Perinatal Pathology course.
- Overseeing the Perinatal Pathology content on the website.