Perinatal Pathology

Usually the perinatal period is from 28 weeks gestation to 4 weeks after birth.

MediScan’s experienced perinatal pathologists examine the tissues of pregnancy, including the placenta, embryo and fetal tissue. When a neonatal death (baby dies in the first 28 days of life) occurs, our perinatal pathologist are well-equipped to perform the autopsy.

Placentas are sent to pathology department for examination based on various indications which include problems in the pregnancy such as hypertension, infection, and diabetes. Placental pathology can also inform neonatal care in specific circumstances such as infection, neurologic injury/encephalopathy or hematologic abnormalities.

Fetal and embryo tissue is examined by a perinatal pathologist when there has been a pregnancy loss. Perinatal pathologists typically perform a thorough examination of the tissues to potentially determine the cause for the pregnancy loss. Depending on state laws, these examinations may be called surgical pathology examinations or autopsies.

The perinatal pathologist reviews cases of in-utero fetal demise or demise in the neonatal period, or terminations due to fetal abnormality or pregnancy complication. The goal is to establish the specific cause of death or complication, and risk of recurrence in subsequent pregnancies.

Diagnosis is often a collaborative effort, so tissue may be taken for ancillary testing including genetics, microbiology and x-rays; and case discussions with pediatric surgeons, obstetricians, and geneticists are sometimes the most intellectually rewarding part of the job.

In Perinatal Pathology the fetus and the placenta are examined in detail. The study includes – external examination, examination of all the organs both by naked eye and under the microscope, and the x ray of the baby for study of the fetal skeleton.

There are three experienced pathologists in the department who study the baby in detail and give a report.

The examination is done after termination of the pregnancy for a severe congenital abnormality identified during pregnancy (on ultrasound) , or when we need to know the possible cause of demise when the baby in inside the uterus (intrauterine demise)

Although the fetus has been examined on ultrasound during pregnancy, since the ultrasound scans cannot identify all the anomalies and the complete extent of the anomalies. If the fetus has died during the pregnancy, the cause of death can be determined in many cases only on examination of the fetus and the placenta.

Only if all the abnormalities in the fetus are identified, a final diagnosis can be arrived at. This ,will help plan further investigations when necessary. With the results one can know whether the condition is likely to recur in subsequent pregnancies or not. This knowledge is essential for the parents and the treating doctor(s) both for reassurance and planning for future pregnancies.

Ideally it should be done soon after delivery. As this may not be possible, one should bring the baby as early as possible. If there is a delay they or the baby is delivered at a time when the department is closed, the baby is preserved in a preservative fluid as described below in point no 10

When the baby is in the womb, its organs are not yet fully developed and cannot perform all the functions necessary for the baby to survive. The baby gets its oxygen, nutrition, and some essentials needed for the wellbeing from the mother through the placenta. If there is some abnormality in the placenta this will be affected and the baby will not thrive. Many of the abnormalities in the placenta can be seen only on examining the tissue under the microscope. Similarly, the umbilical cord and the membranes within which the fetus is enclosed may also show abnormalities. These can be identified only when we do a proper pathological study of the entire placenta. Not examining the placenta will result in missing crucial information.

The doctor or the nurse (in the place of delivery) should wash the baby and immerse it completely in formalin solution (10%). The container should be large, and have a watertight lid. The lid should be further sealed with tape and the container should have a label with the necessary information. The baby should be brought with the medical history and all the investigations done during the pregnancy. All the Scan and blood reports must be there. A requisition letter from the doctor stating the reason for requesting the autopsy is a must.

Preferably the father of the child or an authorized person with due request form and consent form and ID proof of the father / mother.

While giving the baby for a pathological examination, an official of the department will ask some essential questions about the pregnancy, the mother’s health, and family history. The answers to these are crucial for a giving the report. Also, the examination can be done ONLY with a signed consent from one of the parents. The consent form will be given to the father for signing in the department.

In about 6 months. The department will call and inform you when the report is ready.

It can be handed over to the parent or sent by courier whichever is desired by the parents.

For collecting the report in person one of the parents should come (we cannot hand over the report to others for privacy and legal reasons) and bring the yellow card given by the department at the time of handing over the fetus. This card has the department number which is required for handing over the report. This number should be quoted for any enquiry regarding the report or the baby.

The Pathology Department primarily helps in analysis of fetuses with abnormalities which have been terminated. They help to answer questions related to fetal abnormality or death.

Yes, from the Genetic counseling Department, provided the referring doctor has asked for it. Hence, a written request for the same is essential. A prior appointment from the Genetic counseling Department has to be obtained.

The cleaned fetus / placenta have to be preserved in 10 % formalin for testing. (10 % formalin is obtained by mixing 1 part formalin with 10 parts of water).

It should be completely immersed in this liquid.

The container should be of adequate size to preserve the fetus well.

If the fetus is preserved well, the chances of finding answers are better.