Institutional differences in twin placental pathologic assessment

OBJECTIVE: Although standardized guidelines have been proposed tor placental examination, the ability of individual hospitals and pathologists to accurately describe placental findings has not been described. The purpose of this study was to retrospect ely review the variation in quality and accurao of twin placental examination findings in three hospital settings; leniaiy care hospital with dedicated placental pathologist (Hosp A), tertiancare hospital without dedicated placental pathologist {Hosp B), and community hospital (Hosp C). STUDY DESIGN: The placental exam reports from all twin placentas at three different institutions were reviewed (only nionochorionic placentas were reviewed 1'roni the placemal pathologist data base). The time frame reviewed at each hospital was dependent on the availability of computerized records ranging from two to six years. The actual reports were reviewed to determine the (1) number of cord vessels in each cord, (2) type of cord insertion (velamentous, marginal, eccentric), (3) accuracy of amnionicity classification. Fisher's exact test was performed, RESULTS: P vtilne P value Hosp A (A T-.s B) Hosp K (B vs C) Hmp C Absent description 0/7(1 NS 1 '43 .02 15/90 ol cord vessel # Absent description 0/70 .02 4, 43 NS 12/90 of insertion Inaccurate 0/70 .02 1/43 NS 4/90 unninniciu The misidentified placentas were characteri/ed pathological!)' as monoamniotic due to disruption of the amnionswhen in fact both sonographic and delivfi) room assessment had characterised them as diamniotic. CONCLUSION: This studv suggested that significant variation exists among pathologists regarding the quality and accuracy of theii gross placental examination of twin placenta. Adherence to the standardi/ed guidelines will improve this performance.