By Diagnostics World News Staff
November 15, 2024 | Placental pathology has potential to reveal critical insights into pregnancy complications, yet it remains underutilized in clinical trials, argues Dr. Mana Parast, a professor of pathology at the University of California San Diego School of Medicine. By incorporating placental evaluations into clinical research, doctors could better understand and treat conditions like preeclampsia and preterm birth, which are currently diagnosed based only on clinical signs. Parast believes that a comprehensive approach, similar to the integration of tumor pathology in oncology, could benefit obstetrics by combining clinical data with pathology findings to tailor patient care.
In oncology, pathologists and oncologists developed staging systems based on microscopic tumor analysis to guide treatment. A similar method in obstetrics could help determine preventive strategies, such as aspirin therapy for patients with a history of preeclampsia or preterm birth. Placental pathology could also differentiate between types of preeclampsia, potentially guiding treatment. Vascular preeclampsia, often associated with damaged tissue, typically arises earlier in pregnancy, while inflammatory preeclampsia, marked by inflammatory cells, often appears closer to term.
However, several barriers exist. Until recently, there was no standardized protocol for placental sampling, and few trained perinatal pathologists are available to meet clinical demands. Reports often lack actionable insights, limiting their usefulness to obstetricians who may not fully understand pathology findings. Additionally, the financial cost of rapid placental analysis can hinder its clinical application, especially for neonatal intensive care cases.
Institutional resistance also persists, partly due to an underappreciation of the placenta’s diagnostic value. A 2022 article in Obstetrics & Gynecology questioned the relevance of placental pathology due to OBs’ limited understanding of its findings. Parast contends that this skepticism is misplaced, arguing that OBs can gain valuable insights from pathology reports if they collaborate with trained perinatal pathologists.
Most research in placental pathology remains retrospective, limiting its impact on immediate clinical decision-making. Prospective studies could bridge this gap. For instance, guidelines for diagnosing placenta accreta syndrome suggest looking for muscle fibers on the placenta’s maternal side, which can indicate a serious risk for future pregnancies. Standardizing such practices could help identify patients at risk and guide preventive care.
Parast points to the Maternal-Fetal Medicine Units (MFMU) and Neonatal Research Network (NRN), both funded by the National Institute of Child Health and Human Development, as potential allies in advocating for placental pathology’s integration into research. Additionally, patient advocacy groups support the initiative, helping raise awareness among OBs, neonatologists, and pathologists through educational campaigns.
Funding remains a significant challenge. Unlike well-funded initiatives like the BRAIN Initiative, placental pathology research lags due to limited resources, highlighting an imbalance in research priorities within maternal and neonatal health.
For pregnant women, Parast’s advice is proactive: inquire about placental analysis, especially following complications like preeclampsia, and seek a qualified pathologist's report if needed. Self-advocacy in healthcare is often essential, particularly in pregnancy care, where placental insights could be transformative.