Do they help providers?
Valerie Neff Newitt
May 2025—Adding interpretive comments in lay language to placental pathology reports helps physicians and other providers understand the reports and makes it easier for them to share the findings with patients.
That is the unsurprising finding of a survey carried out by authors in the pathology and laboratory medicine and obstetrics and gynecology departments at Endeavor Health in Evanston, Ill., the results of which were published recently (Ernst LM, et al. Arch Pathol Lab Med. Published online Jan. 30, 2025. doi:10.5858/arpa.2024-0105-OA).
“If you make it easier for people to understand, of course they’re going to understand better,” said Linda M. Ernst, MD, MHS, Endeavor’s vice chair for research and director of perinatal pathology, Department of Pathology and Laboratory Medicine, and clinical professor of pathology at the University of Chicago Pritzker School of Medicine. A coauthor of the study, she was recalling the comment of one of the article’s reviewers.
“So we got what we thought we were going to get,” she says of the findings. But, though she suspected this to be the case, “The fact that some providers never talk to their patients about these reports was eye-opening.”
Eye-opening but understandable, she says, noting placental pathology is a young field. “Obstetricians are learning, along with us, about the placenta. They have a lot of responsibilities, and being an expert on the terminology in pathology reports might be pretty low on their list.” This isn’t because it’s unimportant to them, she says, but because “they have a lot going on and it would be understandable if their reaction sometimes is, ‘Whoa, I don’t know what all of this means, but I have to explain it to my patient.’”
“There’s a real need,” she says, “to help obstetricians, as well as patients, understand the reports.”
For the survey, Dr. Ernst drafted comments that explain in lay language the major pathologic findings in the placenta. Three maternal fetal medicine specialists reviewed and refined the comments; they were then reviewed and reworked by an expert in patient and family education at their institution, to improve each comment’s health literacy, and shared with a patient family advisory council.
An invitation to participate in the survey went to 250 Endeavor obstetrics and neonatology providers, including trainees, 31 of whom completed the survey. Thirteen of the 31 were obstetricians with more than five years of experience, six were maternal fetal medicine attending physicians, five were midwives, three were neonatologists, two were obstetricians with less than five years of experience, and two were trainees (one ob/gyn resident, one MFM fellow).
Survey respondents received two hypothetical placental pathology reports, one with and one without lay language comments. They were asked to rate their understanding of the report and comfort level in explaining the report to their patients on a scale of one to four (one is “Don’t understand at all” and four is “Understand it all”; for comfort level, four was “Very comfortable”). They reported greater complete understanding of the report with lay language comments (mean, 3.5) compared with the original report without the comments (mean, 2.97). They reported greater comfort with the report with lay language comments (mean comfort 3.29, compared with 2.81 for the original report). (The two reports that include lay language comments used in the survey can be seen at https://bit.ly/4ipuFlu.)
In a supplemental table (also at https://bit.ly/4ipuFlu), Dr. Ernst and her coauthors list side-by-side examples of medical terminology (provided first below) translated to lay language. Here are a few samples:
- Chronic villitis, chronic intervillositis, chronic deciduitis with plasma cells, chronic marginating choriodeciduitis, chronic chorionitis, chronic decidual perivasculitis, eosinophilic/T-cell vasculitis. Lay language comment: White blood cells, particularly those associated with more long-term swelling or inflammation (chronic inflammation) are noted in the placenta. The cause of this is not fully understood, but chronic inflammation has been associated with preterm labor, intrauterine growth restriction, and infection, and may happen again in a future pregnancy. Chronic inflammation can be seen in up to one-third of normal pregnancies.
- Increased nucleated erythrocytes in the fetal vasculature. Lay language comment: There is an indication that immature/early forms of the baby’s red blood cells are present. This may be seen when there is reduced oxygen flow to the baby or the baby has a low blood count (anemia).
- Accessory lobe, succenturiate lobe. Lay language comment: An accessory lobe of the placenta is an extra, usually round, segment of the placenta tissue at the edge or just off the edge of the main placenta. Usually there are no problems with accessory lobes and only rarely do they cause problems with removal of the placenta or blood flow issues.
- Single umbilical artery. Lay language comment: The umbilical cord normally has three vessels, two arteries and a vein. Occasionally, the umbilical cord will only have two vessels, one artery and one vein. This may or may not be associated with abnormalities in the baby’s growth or formation of organs. Some babies born with only two vessels in the umbilical cord may be screened for abnormalities.
Nineteen of the 31 respondents said they always read the placental pathology report, nine said they almost always read it, two said they sometimes read it, and one said they almost never read the report.
Sixteen said their patients almost never ask them about the placental pathology exam results, 10 said their patients sometimes ask, and five said they’re never asked. Even among the MFM providers, four of six said patients never or almost never ask.
“It’s good for them to know what’s in their pathology reports,” Dr. Ernst says of patients, “and understand if anything needs to be done to safeguard the next pregnancy.”
The main value of the placental pathology examination, she notes, is to understand the adverse outcomes. “Why was there a preterm birth, for instance, or why was the baby small for its gestational age?” Second, defining the pathology may indicate something about the next pregnancy, and it can be helpful to monitor for it. “Third is what happens to the baby. Does placental pathology help us to predict or understand what may happen to a neonate?”
In 2022, Polnaszek, et al., of the maternal fetal medicine divisions at Warren Alpert Medical School of Brown University and Baylor College of Medicine, shared their view that “with the exception of stillbirth and, possibly, unexpected, severe neonatal depression, strict adherence to the ethical practice of outcomes-focused, evidence-based, and cost-effective medicine does not support the majority of placental pathology examinations that are currently performed” (Polnaszek BE, et al. Obstet Gynecol. 2022;139[4]:660–667).
Dr. Ernst and colleagues responded with a review titled “Placental pathology is necessary to understand common pregnancy complications and achieve an improved taxonomy of obstetrical disease” (Redline RW, et al. Am J Obstet Gynecol. 2023;228[2]:187–202).
They wrote: “We think the continuing evaluation of placental pathology is crucial not only for clinical practice but also for future progress in clinical, translational, and basic research in obstetrics and neonatology. We need a better understanding of placental development across gestation and of the underlying etiology of adverse pregnancy outcomes.” They said the Human Placenta Project funded by the National Institute of Child Health and Human Development has prioritized the development of new biomarkers to identify placental diseases early in pregnancy and of therapeutics that permit targeted intervention to prevent serious complications, such as stillbirth and fetal death, fetal growth restriction, and preterm labor.
“The placenta has many secrets yet to be revealed,” they wrote, “and placental pathology is the venue to better understand these relationships between structure and function and pregnancy outcomes.”
One priority in placental pathology is a consensus on terminology and how it’s used, so as not to contribute to provider misunderstanding, and the Amsterdam Placental Workshop Group consensus statement was published in 2016 (Khong TY, et al. Arch Pathol Lab Med. 2016;140[7]:698–713).
“Everybody now who does research in placenta uses the Amsterdam consensus,” Dr. Ernst says. “It’s good and well accepted. There is a constant and continuing effort at improving standardization in terminology and the understanding of it.” She will join a group in Amsterdam next year to continue the work on diagnostic criteria and terminology.
“We have to be consistent in what we see and what we call it and how we report it,” she says. The article published this year based on the survey of 31 practitioners and their report preference is different. “It says, ‘If you have these things in the report, this is what it means.’ But they’re both important,” Dr. Ernst says of the two efforts to communicate clearly.
Which is why she and colleagues are working to improve the understanding of placental pathology findings: “to maximize the value of this diagnostic tool and empower patients to be active partners in their care,” she says. In their 2023 review, Dr. Ernst and coauthors cite the many potential benefits to be gained by engaging patients with placental pathology, among them that there is no feeling that information is being withheld or that there might be discord between specialties.
“But clearly some obstetricians don’t feel comfortable interpreting placental pathology reports for their patients,” she says. The survey showed, she adds, that in addition to the medical language of the pathology report, “if we include additional lay language explanations of those medical terms, we can increase provider comfort and understanding of the reports.” And understanding the terminology and the report’s meaning “is vital to understanding what it means for the patient.”
If adopted widely, the addition of lay language comments in such reports could improve general knowledge about placental pathology, Dr. Ernst and coauthors write in their recent article, “and encourage incorporation of placental pathology findings into both routine clinical practice and novel research trials.”
It’s their view, they write, “that future research breakthroughs and potential treatments aimed at pathophysiologic pathways demonstrated in the placenta are on the horizon, and obstetric providers should remain informed regarding placental pathology findings.”
Valerie Neff Newitt is a writer in Audubon, Pa.