Early Path Medical Consultation Services

Early Path Medical Consultation Services
Pathology Services Working for Safer Pregnancies

What is Perinatal Pathology?

Pathology is the gross and microscopic study of cells and tissues in order to determine the cause and etiology of a disease or outcome. Perinatal pathology includes the study of the placenta, the fetus or the products of conception lost early in a pregnancy. Placental histologic examination would be pointless if it could not provide clinically useful data - consequently, Dr. Salafia's clinical and basic science research of the past 5+ years has been directed toward an improved understanding of the vital contributions that placental examination can make to clinical practice and patient care. The discrimination of patterns of histopathology, potential tissue targets and timing of tissue injury have proven highly beneficial to the specific tailoring of obstetric surveillance plans and therapies in subsequent pregnancies.

The placenta is the fetal lifeline, providing fluids, oxygen, minerals, nutrients, antibodies and many other essentials to the developing fetus while at the same time removing metabolic waste products. There are three primary influences on placental function: maternal blood flow, fetal-placental blood flow and placental trophoblast cell membrane permeability. The placenta, an imperfect venous equilibrator, transfers molecules into the fetoplacental pool proportionate to their concentrations in the maternal circulation. Features limiting fetal oxygenation, nutrition and metabolism are (1) altered maternal perfusion, (2) altered fetoplacental perfusion, (3) reduced placental permeability and (4) increased placental metabolic needs.

As the fetus develops, mechanisms must be in place to increase uterine blood flow to the placenta to compensate for increased fetal needs. If the placenta fails, it is often due to the related failure of the uteroplacental blood vessels to deliver increased uterine blood flow. Extreme degrees of placental failure, which are generally localized, will result in structural placental changes that can be seen by the pathologist. In instances of massive placental failure, the entire placenta shows morphologic changes.

The purpose of the following sections is to describe the role of the major placental disorders often found in pathological pregnancies, and to briefly describe how these processes can be identified in routine placental examination. The goal is to provide an intellectual basis for the use of placental pathologic examination as a comparatively inexpensive screening tool in patients with a first event of poor pregnancy outcome, as an adjunct to the comprehensive evaluation of patients with recurrent pregnancy wastage, and as a key diagnostic tool for patients with pregnancy wastage unexplained after comprehensive clinical and laboratory work-up.

DISCLAIMER: This communication is for educational purposes only and it is not to be used as a substitute for a consultation with your physician. Should you contact Dr. Salafia's office, any responses to you will be based on the information you provide and no attempt will be made to confirm or verify any such information, including any laboratory data you may submit. Questions regarding actual symptoms of illness or health conditions should be addressed to a local health care practitioner who can physically examine and take responsibility for your care throughout the course of your condition/illness, which Dr. Salafia, being a physician licensed to practice medicine only in the State of New York, cannot and will not do. You should NOT use this information to diagnose or treat a health problem; rather, you should consult a qualified health care provider who examines you in person and who is licensed to practice in the state where you are located.