Arvend KugaanHayati Abd RahmanNur Syahrina Binti Rahim2024-05-282024-05-2820192/20/2020Kugaan, Arvend & Rahman, Hayati & Rahim, Nur. (2019). Get hold of the placenta. It is not too late!0126-8635https://oarep.usim.edu.my/handle/123456789/4273Introduction: Examination of placenta provides an insight into the aetiology of stillbirth. Obstetricians and general pathologists have tendency to underestimate the significance of placental examination. We report a case of a perinatal death, where the placenta was retrieved from the burial site and was in fact the cause of death in the stillborn. Case Report: A 26-year-old lady, G2P1 at 28 weeks gestation, was investigated for persistent sudden left upper limb pain and numbness associated with bluish discoloration of the fingers. Further investigations revealed a left ulnar artery stenosis and she was suspected to have microvascular/connective tissue disease. During her admission, a fetal assessment performed showed absence of fetal heart activity. Her first child was born 2 years ago at 35 weeks with low birth weight of 1.28 kg. She subsequently underwent induction of labour and delivered a macerated stillborn. After a small focal sampling of the placenta in the labour room for histopathological examination, it was handed over to the parents for burial purposes. A consent for autopsy was obtained afterwards. Upon request by the pathologists and with the consent of the parents, the placenta disc was immediately retrieved from the burial site within 24 hours. On thorough examination of the placenta, there was a significant area of infarction within the placental disc. Microscopically, there was decidual spiral arterioles vasculopathy. Both the macroscopic and microscopic changes were not seen in the initial tissue sampling. These underlying uteroplacental insufficiency were supportive evidences to the hypoxic mode of death identified at autopsy. Learning Points: Placental examination remains necessary as part of investigations in any stillbirth. In instances where a consent for autopsy cannot be obtained, the placenta may provide the answer to the cause of the perinatal death.enArticle411412413