![]() ![]() The most common route is ascent from the perineum, cervix, and vagina (Fig. Intrauterine infection can follow ascending, hematogenous, transabdominal, or transfallopian pathways. The principal goal of this chapter is to provide a conceptual framework for the obstetrician to better understand the answer to the following questions: What is the underlying process that initiated placental injury, and when in gestation did it begin? What secondary processes may have been recruited (and when) to contribute to the final pathology and pathophysiology of the given pregnancy? Such an analysis, we hope, may help us to understand the persistent health disparities of African-American newborns in the United States. One of us (C.M.S.) is developing data sets to address patterns of tissue injury in preterm birth across ethnic and racial groups. In factor analyses, where a computer program searches for patterns within a data set, patterns of tissue injury have been found to be specific for, for example, principal indication for extreme preterm delivery (see below). Therefore, we are addressing in this chapter the processes of acute inflammation and vascular injury, rather than a series of independent lesions. Obstetric technologies and therapies are also directed toward general pathophysiologic processes (such as uterine and uteroplacental Doppler velocimetry, anticoagulant therapy, and maternal immunization and intravenous gamma globulin) rather than specific lesions or tissue diagnoses. It is illogical to expect that the placenta and its diseases should be any more or less complicated than diseases of the liver and kidney. This comprehensive approach yields not only a summary “label” for the histopathologic findings but also information regarding etiology, prognosis, and optimal therapy. Finally, the pattern is correlated with a variety of clinical data, laboratory data, and additional pathologic studies to produce the final clinical/pathologic diagnosis. Neither hepatocellular necrosis nor glomerulosclerosis, for example, is diagnostic of one and only one hepatic or renal disease in those diseases, individual lesions are considered as part of a greater histopathologic pattern. This would be an unrealistic goal, because in no other organs are such relationships the rule. One important limitation is the inability to make a one-to-one link between any one placental or uteroplacental vascular lesion and a particular maternal or fetal/neonatal problem. For that reason, we have directed our efforts toward clarifying the contributions and limitations of placental examination to clinical practice. Placental pathologic examinations are pointless if they do not provide clinically useful data. ![]() Obstetric endorsement of the utility of placental histologic examination is commonly lukewarm, especially from obstetricians who do not have a placental pathologist as part of their own local clinical care team. The role of the placental pathologist in clinical obstetrics and neonatology has long been controversial. ![]()
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