Obstetrical Clinical Feedback to a Novel Placenta Diagnostic Template.

Abstract

Two recurring themes in placental pathology include (1) the difficulty clinicians have in reading placenta pathology reports; and (2) the irrelevance that many diagnoses have in clinical practice. To create and distribute surveys to local obstetric clinicians, soliciting their opinions of a novel placental pathology report template that is annotated with comments. We composed and sent initial and 2 follow-up surveys (10 months and 28 months after the initial survey) to our community obstetric clinicians to screen their impressions of current and revised placental pathology reports based on Amsterdam criteria categories. After survey feedback, the template was revised and used prior to a follow-up survey. Initial and 2 separate follow-up surveys included 69, 94, and 21 clinicians. Prior to the revision, most clinicians (45; 65%) found placental reports not useful; however, a majority (58; 84%) would modify care of the patient's next pregnancy if they were told that a placental finding predicted future pregnancy risk. In each of 2 follow-up surveys, clinicians were divided on the usefulness of the new reports: 70 (74%) and 8 (53%), respectively, thought that the new format was either a great, or somewhat of an, improvement. Pathologists need to provide placental diagnoses and explanatory comments that provide value-added information related to poor outcomes and recurrence. Follow-up surveys of clinicians suggest that, despite providing more and better organized diagnoses in revised reports, their clinical utility was limited by anxiety caused by distribution to patients and the absence of patient-specific comments. The new template will require additional refinements to provide more focused diagnoses.