The spectrum of placental pathology in a state laboratory vs. a private laboratory practice in Gauteng, South Africa: implications for patient management

Abstract

Background: Laboratory information systems have a wealth of patient and health data available for research. This data can serve to better inform health care and policies. The placenta is just one histopathology laboratory specimen that can provide such insight, particularly with regard to maternal and neonatal health care. Objectives: To describe the spectrum of placental pathology between a private and state laboratory and to ascertain implications for improved maternal and neonatal health care and policies. Methods: We conducted a retrospective descriptive study of placental histopathology reports from Lancet Laboratories, Richmond, and the National Health Laboratory Service (NHLS), Johannesburg over a 1-year period (August 2017 –July 2018). The reports were categorised according to the 2014 Amsterdam Placental Workshop Group Consensus Criteria and the percentages of each diagnostic entity compared between the two laboratories. These diagnostic categories included: ascending infection, maternal vascular malperfusion (MVM), fetal vascular malperfusion (FVM), haematogenous infection, chronic villitis of unknown aetiology (VUE), retroplacental haemorrhage, no specific pathological changes (NSPC) and other.’ Differences in maternal age and gestational age were also compared. Results: There were 1 172 Lancet and 946 NHLS placentas entered into the study. MVM was the most prevalent pathology seen in both laboratories (40.6% and 47.7%; p = 0.3193). Mean maternal and gestational age were both higher within the private system (both p-values <0.0000). Conclusion: Differences in placental pathology were multifactorial and reasons may include differences in socioeconomic status and resources, clinical and laboratory policies, and practices, as well as pathologist training and expertise. Clear clinical guidelines for the submission and histopathological examination of the placenta are required to better inform neonatal and maternal health care and policies. In our divided health system, collaborative medical research is not only possible between the state and private sectors but also necessary to achieve better health care and equity for the betterment of our patient population in South Africa