Stillbirth and intrauterine fetal death: role of routine histopathological placental findings to determine cause of death

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+A: AbstractObjectives There have been many attempts to classify cause of death in stillbirth, all such systems being subjective, allowing for significant observer bias, making accurate comparisons between systems challenging. The aim of this study was to examine factors relating to determination of cause of death by using a large dataset from two specialist centres, in which observer bias has been reduced by objectively classifying findings and assigning causes of death based on predetermined criteria.Methods Detailed autopsy reports from intrauterine fetal deaths (IUFD) during [2005][2006][2007][2008][2009][2010][2011][2012][2013] in the second and third trimesters were reviewed and findings entered into a specially designed database, in which cause of death (CoD) was assigned using predefined objective criteria. Data regarding CoD categories and factors affecting determination of CoD were analysed through queries and statistical tests run using Microsoft Access, Excel, Graph Pad Prism and StatsDirect, with Mann-Whitney U-test and comparison of proportions testing as appropriate.Results There were 1,064 IUFDs, including 639 stillbirths at >23 weeks' gestation.Overall, around 40% (412 (39%)), had a definite or highly likely cause of death identified, whilst 60% (652) were classified as 'unexplained'. Of these, around half had identified risk factors, or lesions of uncertain significance present, whilst the remaining half (292 (45%)) were entirely unexplained. A stepwise increase in the proportion of unexplained deaths was observed with increasing severity of maceration. Black and Asian women had significantly greater proportions of deaths due to ascending infection whilst women aged over 40 had significantly increased placental-related causes of death. There was no significant difference in cause of death distribution by maternal 3 body mass index or with increasing post-mortem interval. Almost 20% of definitive or likely causes of death could be identified from clinical review or external examination / imaging of the fetus, with most of the remainder being determined following placental examination.Conclusions Based on objective criteria, most IUFDs across gestation remain unexplained despite autopsy examination. The rate of unexplained death varies between 30 and 60% depending on interpretation of the significance of features. The cause of death provided across studies is variable and dependent on both the classification system used and subjective interpretation such that reduction in the proportion of 'unexplained' cases across studies is largely based on speculation around mechanism of death. Novel methods to determine objectively the mechanism of death at postmortem examination are required. 4 +A: IntroductionThe primary aim of postmortem investigation of intrauterine death is determination of cause and mechanism of death, to facilitate counseling of parents, management of subsequent pregnancies and future interventions [1][2][3][4] . Over the last 50 years there have been many attempts to classify cause o...

Section: Resultsmentioning

confidence: 97%

Stillbirth and intrauterine fetal death: factors affecting determination of cause of death at autopsy

Man

Hutchinson

Heazell

et al. 2016

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“…Based on weights adjusted for gestational age and fetal sex (delta organ weight), the majority of organs (brain, liver, heart, thymus, lungs, kidneys and thyroid) in SGA fetuses were significantly lighter than those in non‐SGA fetuses ( P < 0.0001, P < 0.0001, P < 0.0001, P < 0.0001, P < 0.0001, P < 0.0001, P = 0.03 respectively). The liver and thymus were significantly lighter in cases with a placental cause of death (defined as abruption, antenatally diagnosed FGR, pre‐eclampsia or definitive placental parenchymal abnormalities) compared with cases of unexplained death ( P < 0.0001 and P = 0.01, respectively).…”

Section: Resultsmentioning

confidence: 98%

Organ weights and ratios for postmortem identification of fetal growth restriction: utility and confounding factors

Man

Hutchinson

Ashworth

et al. 2016

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“…A closer assessment of the origins of this change demonstrates that operator blinding does not significantly influence the detection of lesions in PE pregnancy, but that, in unblinded studies, the operator was much less likely to formally document histological lesions in pregnancies classified as normal. These findings stress the importance of operator blinding, both in a research and clinical context, to get impartial and unbiased reporting of placental pathology, as in other fields 21,22 .…”

Section: Influence Of Operator Blinding On Study Findingsmentioning

confidence: 99%

Placental histopathology associated with pre‐eclampsia: systematic review and meta‐analysis

Falco

Sivanathan

Laoreti

et al. 2017

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