Causes of stillbirth: a clinicopathological study of 243 patients

Hovatta, Outi; Lipasti, Arja; Rapola, Juhani; Karjalainen, O

doi:10.1111/j.1471-0528.1983.tb09296.x

Cited by 101 publications

(58 citation statements)

References 21 publications

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“…e incidence of stillbirth reported from western countries ranges from 4.7% to 12.0%. [4][5][6][7][8][9][10] is is lower than that observed in our study. e reason could be a high number of unsupervised deliveries due to various reason like literacy, low socioeconomic status and the paucity of monitoring facilities in rural areas.…”

Section: Discussioncontrasting

confidence: 76%

Epidemiology of intrauterine fetal death in Dhaka National Medical College Hospital

Bakshi

Hoque²,

Tanjin³

et al. 2017

Bangladesh Med J

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Section: Discussioncontrasting

confidence: 76%

Epidemiology of intrauterine fetal death in Dhaka National Medical College Hospital

Bakshi

Hoque²,

Tanjin³

et al. 2017

Bangladesh Med J

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“…A total of 118 fetuses were excluded because the extent of maceration precluded detailed examination of the brain. Although the degree of maceration can restrict examination of the stillborn fetus, 24 we found that in many cases, the brain was sufficiently well preserved to allow useful observations to be made even in those brains displaying autolysis on naked eye examination. This has been the experience of other groups.…”

Section: Neuropathologymentioning

confidence: 85%

The Scottish Perinatal Neuropathology Study—clinicopathological correlation in stillbirths

Becher

Bell

et al. 2006

BJOG

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Objective To examine the neuropathology of fetuses dying before birth, to determine the timing of any brain damage seen and to ascertain clinical associations of pre-existing brain damage.Design Population-based observational study.Setting All 22 delivery units within Scotland, 1995Scotland, -1998 Sample All stillborn fetuses ‡24 weeks of gestation excluding those with chromosomal abnormality or central nervous system/cardiothoracic malformation.Methods Clinical detail was collected on all stillborn fetuses. Requests for postmortem included separate request for detailed neuropathological examination. Stillborn fetuses were classified as full term antepartum (normal growth/growth restricted), preterm antepartum (normal growth/growth restricted), intrapartum (full term/preterm), multiple births and stillborn fetuses following abruptions. Clinicopathological correlation attempted to define the timing of brain insult. Placentas were examined for each case where available.Main outcome measures Presence of established and/or recent brain damage.Results Clinical details were available for 471 stillborn fetuses, and detailed neuropathology was possible in 191 cases. Of these 191, 13 were multiple births, 9 died following abruption, 12 were intrapartum deaths and 157 were antepartum stillborn fetuses (99 preterm and 58 full term). Recent or established brain damage was seen in 66% of the entire cohort. Thirty-five percent of all cases showed well-established hypoxic damage predating the last evidence of fetal life, and this was more common in preterm fetuses (P = 0.015), those fetuses with evidence of recent damage (P < 0.001), in pregnancies complicated by pregnancy-induced hypertension (P = 0.044) and those in whom the placenta was <10th centile (P = 0.002).Conclusions Brain damage is commonly seen in stillborn infants, and in around one-third of cases, damage predates the period immediately before death. Factors suggesting suboptimal placental function are associated with such damage. Early identification of placental impairment may lead to improved pregnancy outcome.

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“…These systems represent different approaches of classification with different definitions. The selected systems were as follows: the extended Wigglesworth [20], the modified Aberdeen [21], classification by Hey et al [22], by Hovatta et al [23], by de Galan-Roosen et al [24] and by Morrison and Olsen [25]. The reason for choice of the system as well as the system itself will be discussed in the following paragraphs.…”

Section: Used Classification Systems For Cause Of Deathmentioning

confidence: 99%

“…This classification has a pathologic approach based on fetal and neonatal entities and aim is to define the clinicopathological process within the baby and the way they contribute to, and help to explain the baby's death. Hovatta et al [23] designed a system especially for the group of stillbirths. Aim is to classify underlying cause of death considering both clinical and autopsy findings.…”

Section: Placental Cause Of Deathmentioning

confidence: 99%

A Placental Cause of Intra-uterine Fetal Death Depends on the Perinatal Mortality Classification System Used

et al. 2008

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A placental cause of intra-uterine fetal death depends on the perinatal mortality classification system used Korteweg, F.J.; Gordijn, S.J.; Timmer, Albertus; Holm, J.P.; Ravise, J.M.; Erwich, Jan Jaap H. M. Take-down policy If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim. Abstract Different classification systems for the cause of intra-uterine fetal death (IUFD) are used internationally. About two thirds of these deaths are reported as unexplained and placental causes are often not addressed. Differences between systems could have consequences for the validity of vital statistics, for targeting preventive strategies and for counselling parents on recurrence risks. Our objective was to compare use of the Tulip classification with other currently used classification systems for causes of IUFD. We selected the extended Wigglesworth classification, modified Aberdeen and the classifications by Hey, Hovatta, de Galan-Roosen and Morrison. We also selected the ReCoDe system for relevant conditions, comparable to contributing factors in the Tulip classification. Panel classification for 485 IUFD cases in the different systems was performed by assessors after individual investigation of structured patient information. Distribution of cases into cause of death groups for the different systems varied, most of all for the placental and unknown groups. Systems with a high percentage of cases with an unknown cause of death and death groups consisting of clinical manifestations only are not discriminatory. Our largest cause of death group was placental pathology and classification systems without placental cause of death groups or minimal subdivision of this group are not useful in modern perinatal audit as loss of information occurs. The most frequent contributing factor was growth restriction. This illustrates the vital role of the placenta in determination of optimal fetal development. In the Tulip classification, mother, fetus and placenta are addressed together. The system has a clear defined subclassification of the placenta group, a low percentage of unknown causes and is easily applied by a multidisciplinary team. A useful classification aids future research into placental causes of IUFD.

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Causes of stillbirth: a clinicopathological study of 243 patients

Cited by 101 publications

References 21 publications

Epidemiology of intrauterine fetal death in Dhaka National Medical College Hospital

Epidemiology of intrauterine fetal death in Dhaka National Medical College Hospital

The Scottish Perinatal Neuropathology Study—clinicopathological correlation in stillbirths

A Placental Cause of Intra-uterine Fetal Death Depends on the Perinatal Mortality Classification System Used

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