Releasing Placentas to Families: A Unified Recommendation From the Perinatal Committee of the Society for Pediatric Pathology

As perinatal pathologists, we acknowledge that some families would like to take their placenta home with them from the hospital for various sociocultural and/or religious beliefs and practices (eg, special burial, and, not uncommonly, consumption by encapsulation and/or other means of direct ingestion or placentophagy).^1–5  Despite the increasing popularity of this practice, most states in the United States lack clear guidelines for release of the placenta from hospitals.^1,3,5  We respect that the placenta is the property of the family, but feel it is important to offer our insights into the matter, based on our collective experiences and currently available literature.^1–5  This is a proposed consensus guideline constructed by a panel of experts on placental pathology, which aims to (1) guide our colleagues who might be navigating through such requests for the first time and (2) educate on the potential health risks and hospital liabilities that the process may entail.

The group's recommendations are as follows:

Recommendation 1: An institution-tailored policy should, at the minimum, involve representatives from the obstetrics department, the pathology department, infection control, risk management, and the legal department.¹  A suggested outline for forming this group is depicted in Figure 1.

Recommendation 2: The obstetric provider should inform the patient and family that taking the placenta home will prevent gross and microscopic assessment of the placenta by the pathology department and thus the potential diagnosis of clinically significant diseases, including those contributing to recurrent adverse pregnancy outcomes.³ 

Recommendation 3: Further, it is the obstetric provider's responsibility to determine if placental pathologic evaluation is indicated, and to assess the safety risks of releasing the placenta, based on the clinical history (eg, meconium-stained placentas, clinical chorioamnionitis, known maternal viral infections such as HIV and hepatitis B and C among others, and placentas of heavy smokers/substance abusers, which may be deemed unsafe for release)⁴ ; to discuss with the family the importance and potential value of placental pathologic examination; and, following this discussion, to come to a shared decision with the family as to the final placental disposition.

Recommendation 4: Placentas requested for release must not be delivered to the pathology department but must be retained with the mother or in the labor and delivery ward pending discharge from the hospital. Moreover, placentas released to the family must be wrapped in sturdy leak-proof opaque containers, placed in biohazard bags, and kept refrigerated while awaiting transport.³ 

Recommendation 5: A signed waiver of responsibility/specimen release form must be obtained from the family (preferably the mother), which informs the family of the potential biohazardous nature of the placenta and its care in transport and releases the hospital from liabilities that may occur if the placenta carries any infectious disease, which may induce cross-contamination, or if toxic substances cause illness to the recipient.^1,3 

Recommendation 6: Placental consumption is strongly discouraged based on the lack of empirical data confirming benefits of such practice,^1–5  as well as reports of adverse outcomes, including maternal-to-fetal transfer of infectious agents causing life-threatening neonatal sepsis²  and potential accumulation of toxic substances in the placenta.³ 

Recommendation 7: Patient and family must be informed by the obstetric provider that examining the placenta in the pathology laboratory may result in the inability to release the placenta owing to potential contamination in the laboratory. In fact, many institutions do not permit the release of placenta following examination. However, there are institutions that have the capabilities to examine and sample placenta in a quasi-sterile/clean fashion that is subsequently deemed suitable for release post processing; availability of such services must be confirmed and arranged with the pathology department ahead of time. Nevertheless, in our collective opinion, it is safer not to release placentas following pathologic examination (whether in fresh or formalin-fixed state). In case the pathology department (or the hospital) would like to have the option to release the placenta post pathologic evaluation, the risks to the recipient must be outlined in the waiver. Additionally, certain hospital liabilities may arise from releasing placentas that are later found to carry infectious diseases by pathologic examination.

An example of a placenta disposition flowchart (Figure 2) is provided as an overview, which may be used as a quick reference or may be modified depending on an individual institution's policy.

While this matter is deeply personal, some aspects of it—particularly relating to placentophagy, which inevitably requires involvement of medical practitioners for hospital-based deliveries—invite potential risks and liabilities that must be taken into consideration by medical providers and administrators.

This manuscript was also reviewed by the Star Legacy Foundation.