“…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].
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