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The Role of the Placental Pathologist in New York Birth Injury Cases

Excerpt: The placenta is a silent witness to what happened during pregnancy and birth. Placental pathology can provide critical evidence of infection, insufficiency, or acute injury — often deciding the causation element of a CP case.

The Placenta: A Silent Witness

When a baby is born, the placenta is usually discarded as medical waste. But the placenta is a silent witness to everything that happened during pregnancy and birth. It contains a permanent record of:

• Infections that occurred during pregnancy
• Vascular problems that affected blood flow
• Acute events that occurred during labor
• Chronic conditions that developed over weeks or months

In a birth injury lawsuit, placental pathology — the microscopic examination of the placenta by a specialized pathologist — can provide critical evidence that determines whether the brain injury was caused by an acute intrapartum event (medical negligence) or a chronic prenatal condition (not negligence).

For families pursuing a cerebral palsy claim, placental pathology can be the evidence that makes or breaks the case.

[Link to: /birth-injury/hie]

What Is Placental Pathology?

Placental pathology is the examination of the placenta, umbilical cord, and fetal membranes under a microscope by a pathologist — typically a perinatal pathologist or pediatric pathologist with specialized training in placental examination.

The examination includes:

1. Gross Examination

The pathologist visually inspects the placenta for:

• Size and weight — Small placentas may indicate chronic insufficiency
• Shape and completeness — Abnormal shapes or missing pieces may indicate problems
• Umbilical cord — Length, insertion site, knots, or compression
• Membranes — Color, opacity, or signs of infection
• Fetal and maternal surfaces — Clots, infarcts, or calcifications

2. Microscopic Examination

Tissue samples are examined under the microscope for:

• Chorioamnionitis — Infection of the membranes
• Funisitis — Infection of the umbilical cord
• Villous changes — Chronic vascular problems
• Infarcts — Areas of dead tissue from interrupted blood supply
• Thrombi — Blood clots in placental vessels
• Meconium staining — Evidence of fetal distress

When Should the Placenta Be Examined?

The College of American Pathologists (CAP) recommends placental examination in the following situations:

Maternal Indications

• Preterm delivery (< 34 weeks)
• Premature rupture of membranes (PROM)
• Suspected infection (chorioamnionitis, fever)
• Hypertensive disorders (preeclampsia, eclampsia)
• Diabetes
• Substance abuse
• History of poor pregnancy outcomes

Fetal/Neonatal Indications

• Stillbirth or neonatal death
• Low Apgar scores (5-minute Apgar < 7)
• Cord blood pH < 7.0
• NICU admission
• Signs of birth asphyxia or HIE
• Seizures
• Need for therapeutic hypothermia (brain cooling)
• Intrauterine growth restriction (IUGR)

Placental Indications

• Abnormal appearance
• Abnormal cord insertion (velamentous, marginal)
• Single umbilical artery
• Placental abruption
• Abnormal size or weight

How Placental Pathology Proves Causation

In a birth injury case, the defense often argues that the brain injury was caused by a chronic prenatal condition rather than an acute intrapartum event. Placental pathology can refute or support this argument:

Evidence of Acute Intrapartum Injury

• Acute chorioamnionitis — Recent infection that may have contributed to fetal distress
• Acute cord compression — Changes in the cord indicating recent compression
• Abruption — Evidence of recent placental separation
• Acute thrombi — Recent blood clots in placental vessels

Evidence of Chronic Prenatal Injury

• Chronic villitis — Long-standing inflammation
• Chronic vascular lesions — Old infarcts or vascular changes
• Chronic villous changes — Suggesting long-standing insufficiency
• Old thrombi — Organized (old) blood clots

Distinguishing Acute from Chronic

The pathologist can often distinguish acute (recent, occurring during or shortly before labor) from chronic (long-standing, developing over weeks or months) changes based on the cellular characteristics:

| Feature | Acute | Chronic | |---------|-------|---------| | Inflammation | Neutrophils (acute inflammatory cells) | Lymphocytes, plasma cells | | Infarcts | Recent (red, soft) | Old (white, firm) | | Thrombi | Fresh (soft, red) | Organized (firm, pale) | | Villous changes | Acute congestion | Chronic villous atrophy |

Key Pathological Findings in Birth Injury Cases

Chorioamnionitis

Chorioamnionitis is infection of the placental membranes. It can cause:

• Preterm labor — Leading to premature birth
• Fetal inflammatory response — Which can cause brain injury
• Neonatal sepsis — Systemic infection

Acute chorioamnionitis may contribute to intrapartum fetal distress, while chronic chorioamnionitis may indicate a long-standing infection that caused prenatal brain injury.

Funisitis

Funisitis is infection of the umbilical cord. It indicates that the fetal inflammatory response has been activated, which is associated with an increased risk of cerebral palsy — particularly in premature infants.

Placental Abruption

Pathological examination can identify placental abruption — separation of the placenta from the uterine wall. Abruption can cause acute, severe bleeding and fetal oxygen deprivation. The pathologist can determine whether the abruption was recent (acute) or old (chronic).

Infarcts

Placental infarcts are areas of dead placental tissue caused by interrupted blood supply. Multiple or large infarcts may indicate chronic vascular disease (such as preeclampsia) that compromised the fetus over time.

Chronic Villitis

Chronic villitis is inflammation of the placental villi (the functional units of the placenta). It can be caused by infection or immune processes and may indicate a long-standing problem that affected fetal development.

Thrombi

Blood clots in placental vessels can indicate acute or chronic vascular problems. Fetal thrombotic vasculopathy — a condition with multiple thrombi — is associated with neonatal brain injury.

Preserving the Placenta for Examination

For placental pathology to be useful, the placenta must be:

1. Saved at birth — The hospital should preserve the placenta in formalin
2. Examined promptly — Ideally within days of birth
3. Examined by a qualified pathologist — A perinatal or pediatric pathologist, not a general pathologist

If the Placenta Was Not Examined

If the placenta was not examined at the time of birth, it may have been discarded. However, some hospitals retain placental tissue for a period. Your attorney should immediately request:

• Whether the placenta was examined
• The pathology report (if one exists)
• Whether any placental tissue remains

If no pathology was performed and the tissue was discarded, the case becomes more difficult — but not impossible. Other evidence (fetal monitor strips, cord blood gases, MRI findings) can still support the claim.

How the Defense Uses Placental Pathology

The defense may use placental pathology to argue that:

• Chronic infection caused the brain injury prenatally
• Placental insufficiency was a long-standing problem
• The injury was caused by a prenatal vascular event

How the Plaintiff Counters

The plaintiff's perinatal pathologist can:

• Distinguish acute from chronic changes
• Identify evidence of acute intrapartum events
• Correlate placental findings with the clinical picture (fetal monitor strip, cord blood gases, MRI)
• Explain how the findings support intrapartum causation

Expert Witnesses in Placental Pathology Cases

• Perinatal pathologist — To examine the placenta and interpret findings
• Obstetrician — To correlate placental findings with the clinical course
• Neonatologist — To correlate with the neonatal course
• Pediatric neurologist — To establish the causal link to cerebral palsy

Statute of Limitations

Under CPLR 208, the deadline is generally 10 years from the date of birth. However, early action is critical — placental tissue may be discarded if not preserved.

Frequently Asked Questions

What is placental pathology?

Placental pathology is the microscopic examination of the placenta, umbilical cord, and membranes by a specialized pathologist. It can reveal evidence of infection, vascular problems, or acute injury that helps determine the cause of brain damage.

Why is placental pathology important in birth injury cases?

The placenta provides a permanent record of what happened during pregnancy and birth. Pathological examination can distinguish acute intrapartum events (supporting a malpractice claim) from chronic prenatal conditions (supporting the defense).

When should the placenta be examined?

The College of American Pathologists recommends examination in cases of preterm birth, suspected infection, low Apgar scores, cord blood pH < 7.0, NICU admission, signs of birth asphyxia, seizures, or therapeutic hypothermia.

What if the placenta was not examined?

If the placenta was not examined and has been discarded, the case becomes more difficult. However, other evidence (fetal monitor strips, cord blood gases, MRI) can still support the claim. Your attorney should immediately request whether any placental tissue remains.

How does placental pathology help prove causation?

The pathologist can distinguish acute changes (supporting intrapartum injury) from chronic changes (supporting prenatal injury). For example, acute chorioamnionitis or recent abruption supports intrapartum causation, while chronic villitis or old infarcts support prenatal causes.

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If you or a loved one has been affected by cerebral palsy from a birth injury in New York, contact MDLaw Firm at 347-524-5777 for a free consultation.

This article is for informational purposes only and does not constitute legal advice. Prior results do not guarantee a similar outcome. No attorney-client relationship is created by reading this article or contacting MDLaw Firm.