Placental pathology is necessary to understand common pregnancy complications and achieve an improved taxonomy of obstetrical disease

The importance of a fully functioning placenta for a good pregnancy outcome is un-questioned. Loss of function can lead to pregnancy complications and is often detected by a thorough placental pathologic examination. Placental pathology has advanced the science and practice of obstetrics and neonatal-perinatal medicine by classifying dis-eases according to underlying biology and specific patterns of injury. Many past ob-stacles have limited the incorporation of placental findings into both clinical studies and day-to-day practice. Limitations have included variability in the nomenclature used to describe placental lesions, a shortage of perinatal pathologists fully competent to analyze placental specimens, and a troubling lack of understanding of placental diagnoses by clinicians. However, the potential use of placental pathology for phenotypic classification, improved understanding of the biology of adverse pregnancy outcomes, the development of treatment and prevention, and patient counseling has never been greater. This review, written partly in response to a recent critique published in a major obstetrics-gynecology journal, reexamines the role of placental pathology by reviewing current concepts of biology; explaining the most recent terminology; emphasizing the usefulness of specific diagnoses for obstetrician-gynecologists, neonatologists, and patients; previewing up-coming changes in recommendations for placental submission; and suggesting future improvements. These improvements should include further consideration of overall healthcare costs, cost-effectiveness, the clinical value added of placental assessment, improvements in placental pathology education and practice, and leveraging of placental pathology to identify new biomarkers of disease and evaluate novel therapies tailored to specific clinicopathologic phenotypes of both women and infants.

Automated summary

The importance of a fully functioning placenta for a good pregnancy outcome is unquestioned. Placental pathology has advanced the science and practice of obstetrics and neonatal-perinatal medicine. However, obstacles in incorporating placental findings into clinical studies and practice have existed. Nonetheless, the potential use of placental pathology for phenotypic classification, understanding adverse pregnancy outcomes, and developing treatment and prevention has never been greater. This review reexamines the role of placental pathology, explains current concepts and terminology, emphasizes the usefulness of specific diagnoses, and suggests future improvements.