Discard the placenta at your peril, pathologist warns doctors.

Doctors who discard the placenta after a newly born infant dies or is permanently impaired – seemingly during the birth process – could potentially be throwing away their last chance of a legitimate defence should the angry and grieving parents decide to sue. Prof. Colleen Wright, an anatomical patho logist at the National Health Laboratory Services in Port Elizabeth, had specialists and GPs paying close attention at the South African Medical Association's Millennium Development Goals conference this August. Reminding them that the oft-discarded afterbirth placenta was a crucially important fetal organ and therefore a 'map' of what had happened to the infant in utero, she said it was a priceless tool in determining the pathophysiology of an adverse pregnancy outcome. The placenta could uniquely show whether injuries were primarily related to labour/delivery or to an in utero insult long before the onset of labour. Determining the timing of such injuries was invaluable in the medicolegal assessment of cases. Without placental pathology, the attending doctor could be left high and dry in responding to litigation. Wright said numerous studies had shown that babies who had 'an event' during the course of their mother's pregnancy went into labour already compromised. The placenta was normally 'relegated to the sink'. Her experience at Tygerberg Hospital in the year 2000 was that she saw just six placentas from an 'excellent' and extremely busy neonatal unit that year. Through her advocacy and that of her colleagues, this improved to 848 placentas a year (still just 15% of deliveries) by 2004/5, when there were only 30 cases of clinically suspected intrapartum hypoxia. On examination, the placenta was normal in only one of these 30 cases, the remainder all showing some degree of pathology unsuspected by the attending clinician. Existing data from developing countries showed that 90% of neonatal injury occurred before the onset of labour, while the only existing comparative data (from developed countries) showed the percentage of injury due to intrapartum hypoxia to be just 6-10% (estimated to be higher in developing countries). Wright said that the commonest causes of intrapartum hypoxia were placental abruption and cord accidents (i.e. cord prolapse), both sudden and unpredictable events. Where she was now working (Dora Nginza Regional Hospital in Port Elizabeth), nearly every baby delivered with a low Apgar score was labelled as having birth hypoxia. 'If that's seen by a lawyer, it's a field day because you then …