Placenta/cord question...

Specialties Ob/Gyn

Published

I'm writng an argumentative research paper and this question came to mind in the midst of it...

In the case of a fetal demise, at any gestation, is the placenta and cord taken to have a thorough examination done? or does the doctor give in a once over and that's it?

Also, are fetal autopsies routinely done in your hospitals? Are they encouraged or discouraged? What information are the parents given on them?

Thanks!!

obdavisrn

4 Posts

In my experience, placenta and cord are sent to pathology as well as getting the once over from the physician. Autopsies are optional and the majority do them, but sometimes when there is an obvious cause of death like a true knot in the cord or an abruption, there is no need.

LauraLiz

52 Posts

In my experience, placenta and cord are sent to pathology as well as getting the once over from the physician. Autopsies are optional and the majority do them, but sometimes when there is an obvious cause of death like a true knot in the cord or an abruption, there is no need.

That's good to hear the majority do them, from what I've read the autopsy rate has been declining.

Elvish, BSN, DNP, RN, NP

4 Articles; 5,259 Posts

Specializes in Community, OB, Nursery.

In almost all fetal demise cases, the placenta goes to pathology. For what it's worth, in most preterm or complicated deliveries, it gets sent as well. Cord gases get sent too.

We don't do very many autopsies at my place, unless it is a cut-and-dry medical examiner case, which is very rare. Autopsies are expensive, which is why most families opt out of them, in my experience. The docs talk w/ the families and give them the choice with every fetal demise, but most don't opt for it.

What obdavisrn said, though, is pretty spot-on. If there's a cord accident or an abruption, the cause of death is generally pretty obvious. One death I remember recently, the placenta was something like 70% infarcted - so baby not getting much juice to begin with, and there's no real need for an autopsy at that point.

LauraLiz

52 Posts

Do thorough placental pathology exams come at a cost to the parents?

Elvish, BSN, DNP, RN, NP

4 Articles; 5,259 Posts

Specializes in Community, OB, Nursery.

It's one of those things that gets thrown in the whole hospital bill, but it's not a 'doesn't-happen-if-they-don't-pay' sorts of things. An autopsy, on the other hand, if they don't pay for it, it doesn't happen.

Specializes in L&D.

The autopsy is offered to the parents and they decide if they want it or not. The problem is that it rarely shows just exactly what happened. The parents are looking for an answer and so often, it just isn't there.

The placenta is always sent to the lab for examination on any demise.

CARCAM75

58 Posts

Specializes in Labor & Delivery.
I'm writng an argumentative research paper and this question came to mind in the midst of it...

In the case of a fetal demise, at any gestation, is the placenta and cord taken to have a thorough examination done? or does the doctor give in a once over and that's it?

Also, are fetal autopsies routinely done in your hospitals? Are they encouraged or discouraged? What information are the parents given on them?

Thanks!!

In all of the facilities that I've worked in the placenta and cord are first examined/assessed by the OB and then sent to pathology. Fetal autopsies are optional and left to the parents decision as to whether or not they would like one performed. As you can imagine, a fetal demise at any gestation is very distressing to all parties involved (nurse, doctor and especially parents) and more emotional the closer the baby was to term. The autopsies are neither encouraged nor discouraged. The parents are simply informed that the option is available and then measures are taken to assist with their grieving process. I read somewhere in this post that the autopsy rate is decling. I would imagine that being because many parents don't want to further "distress/ damage/ disfigure" their demised baby. They just want to grieve the loss and heal leaving the baby as intact and whole as possible. The mental and emotional strain is just too great. Very few of the patients I've dealt with choose to do an autopsy.

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