by Salina Shafi
Hello everyone! We are starting off our Perinatal Pathology series with this article by Salina showcasing the job of a Perinatal Pathologist. Perinatal Pathology is the study of disorders of the placenta, fetus, and neonate during the time immediately before and after birth. This field of study is not widely known, yet is crucial in understanding more about the health of the mother and baby during pregnancy.
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Her heart dropped. She had felt despair in the pit of her stomach all week. She attempted to convince herself that it was nothing. It was just nervous jitters. Everything was just so new, her relationship, her new job, her new life, and then the fetus that was growing inside of her that was growing. Everything else was a blur, as her partner buzzed on and on about what needed to happen next to make sure that she would be okay. She was told that she needed a pelvic exam. Somehow, a pamphlet landed in her hand with more information about what Perinatal Pathology is and what the term means in her situation. They had no time to process what had happened. In the midst of their emotions, they quickly searched for a perinatal pathologist. She really didn’t know who a perinatal pathologist was or what they did. All she knew was that this medical professional would help them find answers.
What is Perinatal Pathology?
The perinatal section of a pregnancy is around 28 weeks to about four weeks after birth. Perinatal pathology consists of diseases that occur in the placenta and the fetus during the perinatal section of a pregnancy. A perinatal pathologist will work with other healthcare providers to uncover complications or deaths that may arise with a fetus. They will utilize the tissue and other cells from the fetus and the placenta. An Anora is a test that is administered to the tissue that will analyze the chromosome patterns and detect any anomalies.
Just a Feeling
While they waited for the perinatal pathologist, she read through the sections of the pamphlet, all she saw were a bunch of big words that no longer held any value to her. She didn’t know whether to blame herself or even who to blame. She didn’t know what this meant for their future. She really couldn’t bring herself to think of the future right now. “A perinatal pathologist would study the fetus’ tissue to understand what complications arose.” The pamphlet read. It highlighted how perinatal pathologists were scarce and there weren’t many in the area. At least she had the privilege of getting the answers she wanted, some people didn’t have that luxury. She ventured onto google, trying to see if there were reasons why she lost her fetus. She encountered thousands of websites that talked about the different reasons miscarriage happens. She did her best to stay on the accredited resources, until she read a paper that was dismissing supernatural reasons why miscarriage happens. In many places around the world, miscarriages are seen as results of the mother’s actions. She thought about what this meant and quickly dismissed the thought, thinking that they have their beliefs, and she has hers. Before her thoughts could take her anywhere else, the provider knocked on the door.
The provider introduced themself and walked them through the procedure. The couple is then presented with what seemed like a thousand documents that they had to sign. The provider highlighted that they would not perform any test or autopsy without consent. It was decided that they would start with a pelvic exam, followed by some blood tests and testing on the chromosomes. While the provider continued to explain each test in detail, the couple wondered what would happen next. Right before the provider exits the room to place the orders for the test, they mention that the tests may be inconclusive and may not provide any more information than what they were already given. She looked at her partner, a silent conversation passed through them as she told the provider that it will be alright and that they appreciate any attempt of helping them get through this. The pamphlet didn’t say anything about that possibility…
What do Perinatal Pathologists do?
Perinatal Pathologists will perform an autopsy based on a preliminary diagnosis of the situation. Blood tests will be taken to check the levels of human chorionic gonadotropin in the mother's bloodstream. If there are abnormal levels of HCG, it may indicate an issue or suggest that the mother is anemic. Either way, a medical professional will do further tests to assist the patient in their future plans. The Kleihauer-Betke test may also be utilized to analyze the amount of fetal hemoglobin in the mother’s circulatory system.
Figure 1: Kleihauer-Betke test blood smear
The amniotic fluid is there to protect the fetus inside. Performing an amniotic fluid chemistry test will allow providers to see if there were any diseases or other conditions that the fetus had, that would have caused for there to be a miscarriage. Understanding the condition of the amniotic fluid will allow medical professionals to understand any potential illnesses or explanations as to what happened. It is completely possible that various tests are performed, and they come back with results that are considered normal. It can be difficult for providers to try to pinpoint a single reason as to why the miscarriage happened, which is why it is essential to keep that in mind.
Just a Feeling
They sat in the room together, quiet, and not sure how to fill the air with anything other than questions and grief. She didn’t know how to move on, maybe these results would help her understand what happened, or at least give her some sort of closure. That was wishful thinking, she remembered the perinatal pathologist telling them that they may not get the answers they need. Sometimes the most technological tests are enough to explain what happened in a medical case. She looked at her partner and faintly smiled at them. They meet her eyes and smile back, they grabbed her hand and gently squeezed it. A silent promise passes through them as they await the results of what may have happened during the miscarriage.
This is a glimpse of a real story that happens to people every day and around the world. Perinatal pathologists may not be available in every medical clinic and if a clinic does provide their service, then they will work with other providers to ensure that the patient is comfortable and gets the answers they need.
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Thanks for reading the first article in our Perinatal pathology week! We hope you learned about the job of a Perinatal Pathology, and how they can help individuals seek care during pregnancy.
If you liked this article, check out our Dance Medicine article by Alexandra! And be on the lookout for the next article in our Perinatal Pathology week, coming out tommorow!
Until next time,
Salina and the Writing Committee :)
References
About perinatal pathology. Society for Pediatric Pathology. (n.d.). Retrieved August 10, 2022, from https://www.spponline.org/about-perinatal-pathology
Ugwumadu, A. (2015). Management of stillbirth and perinatal loss. Obstetrics, Gynaecology and Reproductive Medicine, 25(8), 217-221. https://doi.org/10.1016/j.ogrm.2015.05.002