PFM.30 Should placental histology be abandoned in times of national financial austerity?

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Abstract

Introduction

In times of financial austerity results of investigations requested by clinicians must be demonstrated to influence practice.

Setting

Tertiary maternity unit with Level 3 Neonatal unit.

Methods

All requests for placental histology following livebirths during January 2012 were reviewed against trust guidelines. 28 cases were identified and all casenotes for mothers and babies were reviewed.

Results

21 (75%) requests for histological examination were indicated in accordance with local guidelines. In no cases were the results of the placental histological examination found to influence the mother’s management, either immediately or in future pregnancies (2 women had a further pregnancy at the time of review). Local neonatal guidance recommends cranial ultrasonography in the presence of a histological diagnosis of chorioamnionitis. Of those babies in whom this was indicated 70% underwent cranial ultrasound.

Conclusions

Results of placental histological examination have no direct influence on management of the current post natal period or future pregnancies in our unit. Placental histological examination may have a role in providing guidance regarding frequency and timing of cranial ultrasound in neonates, but does not appear to alter other short term neonatal management. Each placental examination costs £48; In 2012 616 examinations were performed in our unit. Abandoning the procedure could result in a cost saving of £29,568 per annum.

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