Improving Compliance with Placental Histopathology Through Labour Ward Storage and Clear Referral Criteria: a Two-Site Quality Improvement Report

Placental histopathology is central to good perinatal care, offering insight into antepartum and intrapartum events, informing neonatal management and supporting counselling for future pregnancies. Despite clear national guidance, many placentas that meet criteria are not sent for evaluation. Reasons are multifactorial, including inconsistent awareness of indications and unclear post-delivery processes. Two UK maternity units, St Thomas’ Hospital in London and the Royal Berkshire Hospital in Reading, identified local variations in practice that led to placentas not being appropriately sent. At St Thomas’ Hospital, a baseline audit performed as part of a preterm birth research study revealed only 80% of eligible deliveries had placental examination. At the Royal Berkshire Hospital, a coroner’s inquest after an unexpected neonatal death, highlighted the absence of indicated placental histology, prompting a recommendation for 48-hour retention of all placentas. A quality improvement project using Plan Do Study Act cycles was implemented at both sites. Interventions included installation of dedicated labour ward fridges for 48-hour storage with temperature monitoring, targeted education on indications for placental histology and daily cross-checking of neonatal admissions to ensure eligible placentas were sent. The primary outcome was the proportion of placentas meeting criteria sent for histopathology, focusing on deliveries <32 weeks and intrauterine deaths >18 weeks. National investigation reports at St Thomas’ Hospital were also reviewed for missing histology. Labour ward storage proved feasible and effective. At the Royal Berkshire Hospital, submission rates improved from 88% to 97% for intrauterine deaths and from 71% to 100% for very preterm births. At St Thomas’ Hospital, preterm submissions increased from 80% to 96% after education and 98% after storage, with intrauterine death remaining at 100%. Missing histology in national investigations reduced from 12% to 0%. Short-term placental storage is a low-cost, scalable intervention aligned with national maternity safety priorities.