The spectrum of placental pathology in a public v. private laboratory practice in Gauteng Province, South Africa

IF 0.4 Q4 OBSTETRICS & GYNECOLOGY South African Journal of Obstetrics and Gynaecology Pub Date : 2020-12-15 DOI:10.7196/SAJOG.1599
M. Savage-Reid, C. Wright, R. Wadee
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Abstract

Background. Laboratory information systems have a wealth of patient and health data that can be made available for research. These data can serve to better inform healthcare delivery and formulation of policies. The placenta is just one histopathology laboratory specimen that can provide such insight, particularly with regard to maternal and neonatal healthcare.  Objectives. To describe the spectrum of placental pathology in a private and public laboratory and to ascertain implications for improved maternal and neonatal healthcare and policies.  Methods. We conducted a retrospective descriptive study of placental histopathology reports from Lancet Laboratories and the National Health Laboratory Service (NHLS) in Johannesburg over a 1-year period (August 2017 - July 2018). The reports were categorised according to the 2014 Amsterdam Placental Workshop Group Consensus Statement 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, haematogenous infection, chronic villitis of unknown aetiology, retroplacental haemorrhage, no specific pathological changes and ‘other’. Differences in maternal age and gestational age were also compared.  Results. There were 1 172 and 946 placentas that were entered into the study at Lancet and NHLS, respectively. 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 in the private system (both p <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 healthcare and policies. In our divided healthcare system, collaborative medical research is not only possible between the public and private sectors but also necessary to achieve better healthcare and equity for patients in South Africa.
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南非豪登省公共与私人实验室实践中的胎盘病理学谱
背景实验室信息系统拥有丰富的患者和健康数据,可用于研究。这些数据可以更好地为医疗服务的提供和政策的制定提供信息。胎盘只是一个组织病理学实验室标本,可以提供这样的见解,特别是在孕产妇和新生儿保健方面。目标。描述私人和公共实验室中胎盘病理学的范围,并确定对改善孕产妇和新生儿保健和政策的影响。方法。我们对约翰内斯堡柳叶刀实验室和国家卫生实验室(NHLS)在一年内(2017年8月至2018年7月)的胎盘组织病理学报告进行了回顾性描述性研究。根据2014年阿姆斯特丹胎盘工作坊小组共识声明以及两个实验室之间每个诊断实体的百分比对报告进行分类。这些诊断类别包括上行感染、母体血管灌注不良(MVM)、胎儿血管灌注不良、血液源性感染、病因不明的慢性绒毛炎、胎盘后出血、无特定病理变化和“其他”。还比较了产妇年龄和胎龄的差异。结果。Lancet和NHLS分别有1172和946个胎盘参与了这项研究。MVM是两个实验室中最常见的病理学(40.6%和47.7%;p=0.3193)。在私人系统中,平均产妇和胎龄均较高(均p<0.0000)。结论。胎盘病理学的差异是多因素的,原因可能包括社会经济地位和资源、临床和实验室政策和实践以及病理学家培训和专业知识的差异。需要明确的胎盘提交和组织病理学检查的临床指南,以更好地为新生儿和产妇的医疗保健和政策提供信息。在我们分裂的医疗体系中,公共和私营部门之间的合作医疗研究不仅是可能的,而且对于南非实现更好的医疗保健和患者公平也是必要的。
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来源期刊
South African Journal of Obstetrics and Gynaecology
South African Journal of Obstetrics and Gynaecology Medicine-Obstetrics and Gynecology
CiteScore
0.40
自引率
0.00%
发文量
5
审稿时长
15 weeks
期刊介绍: The SAJOG is a tri-annual, general specialist obstetrics and gynaecology journal that publishes original, peer-reviewed work in all areas of obstetrics and gynaecology, including contraception, urogynaecology, fertility, oncology and clinical practice. The journal carries original research articles, editorials, clinical practice, personal opinion, South Africa health-related news, obituaries and general correspondence.
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