A perinatal pathologist examines the tissue related to pregnancy—namely the placenta, embryo and fetal tissue. When fetal or neonatal death occurs, they are responsible for the autopsy and for determining the reasons for poor pregnancy outcomes.
When complications in a newborn arise, such as unexplained infections or a rare disease like fetal and neonatal alloimmune thrombocytopenia (FNAIT), and end in death, a perinatal pathologist examines the placenta to understand how and why the complications occurred.
The role of the perinatal pathologist
The perinatal period refers to the time immediately before and after birth, from 28 weeks’ gestation to four weeks post-delivery. Perinatal pathologists are experts in diseases of the placenta and most often intervene in cases where the baby has died during pregnancy or birth. This can include pregnancy loss as a result of miscarriage, stillbirth or neonatal death.
Perinatal pathologists examine the placenta and perform the perinatal postmortem examination to identify the reasons for the pregnancy loss and to avoid it happening again in future pregnancies. However, they may also examine the placenta of live births where unexplained or unexpected complications have occurred.
The role of the perinatal pathologist in FNAIT
In pregnancies affected by FNAIT, a perinatal pathologist may become involved following the death of the baby during pregnancy, birth or post-delivery. This may be the case if FNAIT has not been diagnosed and the cause of death is unidentified.
In FNAIT, a perinatal pathologist may also be asked to examine the placenta following a live birth to better understand the complications, confirm diagnosis and advise the family on how to proceed in future pregnancies to reduce the risk of recurrence.
Part of a multidisciplinary healthcare team
A perinatal pathologist works as part of a broader healthcare team, working closely with obstetricians, maternal-fetal medicine specialists, neonatologists, pediatricians, geneticists, other pathologists, counsellors and bereavement specialists.
They work as part of a multidisciplinary team that coordinates clinical investigation, diagnostic and genetic information and emotional support. Their role is an integral part of supporting families coping with a difficult experience involving the unexpected loss of their baby or the occurrence of complications.
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