Post-Mortem Magnetic Resonance Imaging Appearances of Feticide in Perinatal Deaths

Abstract

Objective: The aim of this study was to characterise the imaging features seen in fetuses having undergone feticide by intracardiac potassium chloride injection compared to those of non-terminated fetuses at post-mortem magnetic resonance imaging (PMMRI). Methods: A case-control study was performed comparing PMMRI findings between two groups of patients – those having undergone feticide were matched to a control group of miscarried/stillborn fetuses. The groups were matched according to gestational age, weight, and time since death. Two independent readers reviewed the PMMRI for thoracic, abdominal, and musculoskeletal imaging features. The Fishers exact test was conducted for differences between the patient groups. Results: Twenty-six cases of feticide (mean gestation 25 weeks [20–36]) and 75 non-terminated fetuses (mean gestation 26.7 weeks [19–36]) were compared. There was a higher proportion of feticide cases demonstrating pneumothorax (23.1 vs. 1.3%, p = 0.001), haemothorax (42.3 vs. 4%, p = 0.001), pneumopericardium (30.8 vs. 5.3%, p = 0.002), and haemopericardium (34.6 vs. 0%, p = 0.0001). Intracardiac gas and intra-abdominal findings were higher in the feticide group, but the differences were not statistically significant. Conclusion: Characteristic PMMRI features of feticide can help improve reporter confidence in differentiating iatrogenic from physiological/pathological processes.

Maceration determines diagnostic yield of fetal and neonatal whole body post‐mortem ultrasound

“…From the finalised autopsy report, conducted by one of seven specialist consultant paediatric pathologists at our centre, the demographic details and biometric measurements taken at the external examination of the autopsy were also entered into the database, including the following: Patient gender (male, female, or undetermined); Gestational age (weeks); Post‐mortem weight (g); Crown‐rump length (CRL) (cm); Crown‐heel length (CHL) (cm); Head circumference (HC) (cm); Post‐mortem interval (PMI, days) (ie, the time between death [for neonatal deaths] or delivery [for terminations of pregnancy, stillbirths and intrauterine fetal deaths] and the PMUS); Mode of death/delivery; and Maceration score (maceration is the process of tissue autolysis, which occurs during intrauterine fetal retention . Given that the exact timing of fetal demise in utero is difficult and therefore, the length of intrauterine retention, a standard pathologist assessment of the body at external examination was scored from 0 = no maceration to 3 = severe/established maceration, as per previous publications). …”

Is traditional perinatal autopsy needed after detailed fetal ultrasound and post‐mortem MRI?

“…Demographic details collected for each case included date of birth, death, gestational age, post‐mortem weight, subjective degree of maceration at autopsy (based on standard criteria involving external evaluation of the fetus including skin slippage, skin discolouration, and overlapping of the skull structures, arbitrarily scored from 0 to 3; 0 representing none, 1 mild, 2 moderate, and 3 established maceration), number of days between delivery and PMMR, days between delivery and autopsy, and mode of death (eg, termination of pregnancy, stillbirth, and miscarriage).…”

Perinatal post mortem ultrasound (PMUS): a practical approach

“…intra-cardiac injection of a toxic agent, such as potassium chloride) can cause haemorrhage (i.e. fluid with internal debris) and gas within the pericardium and pleural spaces, and this should be recognised as iatrogenic and correlated with the antenatal history [ 31 ] (Fig. 9 ).…”