Strategies for Addressing Recurrent Pregnancy Loss (Virtual Symposium)-HANDOUT: 04-Roberts-Decoding_the

HANDOUT: 04-Roberts-Decoding_the_Placenta

Pdf Summary

The presentation by Drucilla J. Roberts, MD, emphasizes the clinical significance of placental pathology in maternal, fetal, and neonatal health. Placental examination provides essential benefits including auditing antenatal management, identifying causes of adverse pregnancy outcomes, and guiding future pregnancy care through recognition of recurrent or treatable conditions. It also aids in timely interventions, understanding long-term neonatal and maternal morbidity, medicolegal resolution, and prognosis.<br /><br />Key maternal implications involve determining the timing and severity of pathological processes linked to maternal mortality and disease, including metastatic malignancies and recurring placental conditions. For the fetus and neonate, placental pathology is crucial in diagnosing the etiology of pregnancy loss, hypoxic-ischemic encephalopathy, infections, and embolic stroke. Histological findings such as placental mesenchymal dysplasia (linked to Beckwith-Wiedemann syndrome), adherent myometrial fibers (risk factor for morbidly adherent placenta in future pregnancies), and infection-related inflammation underscore diverse clinical impacts.<br /><br />Cases highlight clinical scenarios such as term deliveries complicated by placental abnormalities causing postpartum hemorrhage, neonatal seizures linked to embolic strokes, and congenital cytomegalovirus (CMV) placentitis leading to neonatal complications. The pathology also includes rare but critical diagnoses like intraplacental choriocarcinoma and metastatic maternal cancers, which have significant prognostic and treatment implications for both mother and infant.<br /><br />Acute and chronic chorioamnionitis, fetal inflammatory response, and meconium-associated myonecrosis are important pathological entities associated with neonatal morbidity and neurological impairments such as cerebral palsy. Early placental diagnosis facilitates interventions, parental counseling, and neonatal care planning.<br /><br />Overall, comprehensive placental examination supports improved patient outcomes by clarifying etiologies, informing clinicians about current and future risks, and enabling prompt neonatal and maternal care. The presenter advocates for multi-disciplinary communication, awareness of diagnostic limits, and consistent pathology referral criteria to maximize the clinical utility of placental findings.

Keywords

placental pathology

maternal health

fetal health

neonatal health

pregnancy complications

placental examination

chorioamnionitis

placental mesenchymal dysplasia

metastatic malignancies

neonatal seizures