The perinatal postmortem examination

Abstract

SYNOPSIS In order to determine the cause of a perinatal death it is important to correlate the postmortem findings with the clinical histories of both mother and infant. The postmortem examination of a newborn infant differs from that of an adult in a number of ways, especially in the method of removal and dissection of the brain, the examination of the cervical spine, the dissection of the cardiovascular system for congenital abnormalities, and the examination ofthe placenta. A systematic technique for performing a perinatal necropsy is described. Stress is laid on measurement of the size of the infant and of the individual organs and comparison of these with known standards, allowance being made for the maturity of the infant.

Assessment of “fresh” versus “macerated” as accurate markers of time since intrauterine fetal demise in low‐income countries

“…We used 8 hours as our cutoff time based on the most commonly used maceration criteria described by Langley [15]; this is also the timing mentioned in the practice guidelines for perinatal autopsy for the Autopsy Committee of the College of American Pathologists [16]. If both the minimum and the maximum death‐to‐delivery intervals were less than 8 hours or both were more than 8 hours, the classification was straightforward.…”

A perinatal mortality survey in south-east London, 1970-73: the pathological findings in 726 necropsies.

“…These infants had comparatively rare lesions that did not fit into the major categories above. Tissue blocks were taken for histology, as recommended by Langley (1971), and particular attention was directed to pulmonary histology.…”

Stillbirth: Case definition and guidelines for data collection, analysis, and presentation of maternal immunization safety data

“…Macroscopic appearance of the fetus may show signs of maceration and the level of maceration can determine time of death. The earliest sign of macerations are seen in the skin 4–6 h after intrauterine death; desquamated skin measuring 1 cm or more in diameter and red or brown discoloration of the umbilical cord correlate with fetal death 6 or more hours before birth; desquamation involving the skin of face, back or abdomen with 12 or more hours; desquamation of 5% or more of the body surface with 18 or more hours; moderate to severe desquamation, brown skin discoloration of the abdomen with 24 or more hours and mummification is seen in fetuses who died 2 or more weeks before birth [55]. Radiologic studies : In addition to the above clinical signs, other secondary features might be seen antepartum if eventually imaging techniques such as X-ray radiography are used: collapse of the fetal skull with overlapping bones due to liquefaction of the brain, hydrops, flattening of the cranial cavity, head asymmetry, fall of the mandible (sign of open mouth), or fetal bunching due to a loss of the normal curvature of the spine due to macerating spinal ligaments, which may appear completely collapsed resulting in unrecognizable fetal mass. In addition, there might be also intra-fetal gas within the heart, blood vessels and joints or a translucent peri-cranial halo due to accumulation of fluid in the subcutaneous tissue; when the image is complete gives double cranial halo called “holy crown” [56], [57], [58], [59], [60].…”

“…Macroscopic appearance of the fetus may show signs of maceration and the level of maceration can determine time of death. The earliest sign of macerations are seen in the skin 4–6 h after intrauterine death; desquamated skin measuring 1 cm or more in diameter and red or brown discoloration of the umbilical cord correlate with fetal death 6 or more hours before birth; desquamation involving the skin of face, back or abdomen with 12 or more hours; desquamation of 5% or more of the body surface with 18 or more hours; moderate to severe desquamation, brown skin discoloration of the abdomen with 24 or more hours and mummification is seen in fetuses who died 2 or more weeks before birth [55].…”