RESUMO
The importance of a fully functioning placenta for a good pregnancy outcome is unquestioned. Loss of function can lead to pregnancy complications and is often detected by a thorough placental pathologic examination. Placental pathology has advanced the science and practice of obstetrics and neonatal-perinatal medicine by classifying diseases according to underlying biology and specific patterns of injury. Many past obstacles have limited the incorporation of placental findings into both clinical studies and day-to-day practice. Limitations have included variability in the nomenclature used to describe placental lesions, a shortage of perinatal pathologists fully competent to analyze placental specimens, and a troubling lack of understanding of placental diagnoses by clinicians. However, the potential use of placental pathology for phenotypic classification, improved understanding of the biology of adverse pregnancy outcomes, the development of treatment and prevention, and patient counseling has never been greater. This review, written partly in response to a recent critique published in a major obstetrics-gynecology journal, reexamines the role of placental pathology by reviewing current concepts of biology; explaining the most recent terminology; emphasizing the usefulness of specific diagnoses for obstetrician-gynecologists, neonatologists, and patients; previewing upcoming changes in recommendations for placental submission; and suggesting future improvements. These improvements should include further consideration of overall healthcare costs, cost-effectiveness, the clinical value added of placental assessment, improvements in placental pathology education and practice, and leveraging of placental pathology to identify new biomarkers of disease and evaluate novel therapies tailored to specific clinicopathologic phenotypes of both women and infants.
Assuntos
Placenta , Complicações na Gravidez , Humanos , Gravidez , Feminino , Placenta/patologia , Resultado da GravidezAssuntos
Diabetes Gestacional , Gravidez em Diabéticas , Feminino , Humanos , Gravidez , Diabetes Gestacional/diagnóstico , Diabetes Gestacional/terapia , Primeiro Trimestre da Gravidez , Segundo Trimestre da Gravidez , Gravidez em Diabéticas/diagnóstico , Gravidez em Diabéticas/terapia , Programas de RastreamentoAssuntos
Caproato de 17 alfa-Hidroxiprogesterona/uso terapêutico , Negro ou Afro-Americano , Aprovação de Drogas , Nascimento Prematuro/prevenção & controle , Progestinas/uso terapêutico , United States Food and Drug Administration , Ensaios Clínicos como Assunto , Feminino , Disparidades nos Níveis de Saúde , Humanos , Gravidez , Nascimento Prematuro/etnologia , Fatores de Risco , Estados UnidosAssuntos
Aborto Espontâneo , Ameaça de Aborto , Feminino , Hemorragia , Humanos , Gravidez , ProgesteronaAssuntos
Comportamento de Escolha , Trabalho de Parto Induzido , Feminino , Humanos , Gravidez , Fatores de RiscoAssuntos
Aspirina , Pré-Eclâmpsia , Feminino , Humanos , Inibidores da Agregação Plaquetária , Gravidez , Fatores de RiscoAssuntos
Carcinoma Adenoescamoso/cirurgia , Histerectomia , Complicações Neoplásicas na Gravidez/cirurgia , Neoplasias do Colo do Útero/cirurgia , Adulto , Carcinoma Adenoescamoso/patologia , Carcinoma Adenoescamoso/radioterapia , Cesárea , Terapia Combinada , Feminino , Humanos , Estadiamento de Neoplasias , Ovariectomia , Gravidez , Complicações Neoplásicas na Gravidez/patologia , Complicações Neoplásicas na Gravidez/radioterapia , Prognóstico , Isoimunização Rh , Salpingectomia , Taxa de Sobrevida , Neoplasias do Colo do Útero/patologia , Neoplasias do Colo do Útero/radioterapiaAssuntos
Abortivos Esteroides , Rotulagem de Medicamentos/legislação & jurisprudência , Regulamentação Governamental , Mifepristona , Abortivos Esteroides/administração & dosagem , Feminino , Humanos , Mifepristona/administração & dosagem , Gravidez , Governo Estadual , Estados Unidos , United States Food and Drug AdministrationRESUMO
To address information gaps that limit informed clinical decisions on medication use in pregnancy, the Centers for Disease Control and Prevention (CDC) solicited expert input on a draft prototype outlining a systematic approach to evaluating the quality and strength of existing evidence for associated risks. The draft prototype outlined a process for the systematic review of available evidence and deliberations by a panel of experts to inform clinical decision making for managing health conditions in pregnancy. At an expert meeting convened by the CDC in January 2013, participants divided into working groups discussed decision points within the prototype. This report summarizes their discussions of best practices for formulating an expert review process, developing evidence summaries and treatment guidance, and disseminating information. There is clear recognition of current knowledge gaps and a strong collaboration of federal partners, academic experts, and professional organizations willing to work together toward safer medication use during pregnancy.