[CG] NHSGGC Pathology Placenta Examination Request Form

Abstract

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Send placenta and this request form to: Department of Pathology, Level 3, Laboratory Medicine Building, Queen Elizabeth University Hospital, Glasgow, G51 4TF

GESTATIONAL AGE AND CLINICAL INDICATION MUST BE STATED ON THE REQUEST FORM
PLACENTAS WITH INSUFFICIENT CLINICAL DETAILS WILL BE STORED ONLY

Indications for referring placentas:

Placentas with the following are NOT indicated for examination unless there are further relevant indications:

✓ Stillbirth / second trimester fetal death
✓ Preterm delivery less than 34 weeks
✓ SGA (birthweight below 10th centile or discordance >=25% in twins)
✓ Abruption
✓ Fetal hydrops
✓ Undiagnosed fetal anomaly
✓ Molar pregnancy (current pregnancy only)
✓ pH <7.1
✓ Any baby admitted to NNU or SCBU due to severe fetal distress
✓ Complicated twin pregnancy
✓ Other indications at the discretion of the Obstetrician

 Pre-eclampsia
 Maternal sepsis
 Known trisomy 13, 18,21
 Normal dichorionic twin pregnancy
 Cholestasis
 Hepatitis B/C, HIV
 Maternal disease with normal pregnancy outcome
 Normal pregnancy
 Placenta with accessory lobe
 “Fetal distress” not fulfilling the above indications.

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