The role of fetal autopsy and placental examination in the causes of fetal death: a retrospective study of 132 cases of stillbirths

Bonetti, Lorenzo; Ferrari, Paolo; Trani, Nicoletta; Macciò, Livia; Schirosi, Laura; Sartori, Giuliana; Facchinetti, Fabio; Rivasi, Francesco

doi:10.1007/s00404-009-1317-4

Cited by 49 publications

(45 citation statements)

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“…Bonetti et al, were able to find reasonable cause of death in 79.8% cases of fetal autopsy in their study. They found that the major relevant conditions associated to stillbirth were feto-placental infection in early gestational age (GA) and placental insufficiency both in early and late GA, mainly associated with intrauterine growth retardation [17].…”

Section: Discussionmentioning

confidence: 99%

“…Placental anomalies were mainly represented by avascular villi with stromal fibrosis associated with thrombosis of major and minor vessels in placental insufficiency cases [17] [Table/ Fig-5,6]. Soma and colleagues [18] found placental infarction in 54.7% cases of toxemia which was the most common lesion found in pregnancy induced Hypertension (PIH)/ pre-eclamptic toxemia (PET).…”

Section: Discussionmentioning

confidence: 99%

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Foetal Autopsy-Categories and Causes of Death

Fatima

Sherwani

Khan

et al. 2014

JCDR

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Foetal Autopsy-Categories and Causes of Death

Fatima

Sherwani

Khan

et al. 2014

JCDR

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“…Pathologic evaluation of D&E specimens for midtrimester IUFD has not been studied in the literature to our knowledge. However, there are several recent studies [58][59][60][61][62][63] that have examined the value of pathologic examination of the fetus and placenta for intact fetuses in setting of IUFD, and the American College of Obstetricians and Gynecologists 64 recommends autopsy and placental evaluation be offered for all stillbirths. A study of the Stillbirth Collaborative Research Network 58 involving 663 stillbirths in both the second and third trimesters, and including postmortem examinations in more than 500 patients, showed that 66% of stillbirths have at least 1 positive result among the 3 major components of the evaluation: perinatal autopsy, placental examination, or karyotype.…”

Section: 54mentioning

confidence: 99%

Pathologic Examination of Fetal and Placental Tissue Obtained by Dilation and Evacuation

Ernst

Gawron

Fritsch

2013

Archives of Pathology &Amp; Laboratory Medicine

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Context.-Dilation and evacuation (D&E) is an alternative method to induction of labor for pregnancy termination and intrauterine fetal demise, and it is the most common mode of second-trimester uterine evacuation in the United States. Many D&E specimens are examined in surgical pathology, and there is little information available in surgical pathology textbooks or the literature to assist pathologists in these examinations.Objective.-To provide an overview of the D&E procedure, discuss related legal issues, provide guidelines for routine pathologic examination of D&E specimens, and demonstrate the importance of careful pathologic examination of D&E specimens.Data Sources.-Case-derived material and literature review.Conclusions.-Pathologic examination of D&E specimens has been understudied. However, the available literature and our experience support the fact that careful pathologic examination of D&E specimens can identify significant fetal and placental changes that can confirm clinical diagnoses or provide definitive diagnosis, assist in explaining the cause of intrauterine fetal demise, and identify unexpected anomalies that may provide further clues to a diagnostic syndrome or mechanism of anomaly formation.(Arch Pathol Lab Med. 2013;137:326-337; doi: 10.5858/ arpa.2012-0090-RA) P athologic examination of products of conception in routine surgical pathology practice consists largely of the gross and microscopic examination of fragmented fetal and placental tissue from first-trimester missed or induced abortions. The majority of these pathology specimens are handled grossly by technicians, and for the most part, the main goal is the pathologic documentation of chorionic villi and fetal parts. However, pathologists, especially at large academic medical centers, are encountering an increasing number of disrupted, second-trimester fetal specimens for examination. Prior to the 1970s, uterine evacuation in the second trimester was accomplished via labor induction methods, such as prostaglandin or saline instillation, or by hysterotomy, and resulted in an intact fetus. The development of the dilation and evacuation (D&E) procedure during this time period gave an alternative to these methods. In 1974, only 36% of all midtrimester abortions were managed via D&E, but the safety and popularity of this method increased that number to 96% in 2005. 1 The development of a fellowship in family planning in 1991 has trained a new generation of academic D&E providers. This is a 2-year postgraduate training program for obstetrician-gynecologists and focuses on advanced clinical skills, research, and teaching in the field of contraception and abortion. A total of 179 fellows have graduated, with 79% holding positions in academic centers.2 The addition of a trained fellow to an institution will increase access to D&E services and allow women options for management of an unintended or abnormal pregnancy. Women have been shown to preferentially choose management via D&E over labor induction in the second trimester, avoiding an unpr...

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Section: Interpretation Of Findingsmentioning

confidence: 99%

“…Furthermore, it is unclear which clinical scenario results in the highest yield of information for autopsy following stillbirth. It has been reported that autopsy together with placental examinations could contribute to decreasing the rate of unexplained stillbirths [312].It was a paradoxical finding that stillbirths occurring at 28 weeks or more that were unexplained at the time of completing the death certificate were less likely to have an autopsy. The reason for this was not immediately clear.…”

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confidence: 99%

Preventing stillbirths: Better data to inform interventions in Australia

Ibiebele¹

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BackgroundIn Australia, one in every 139 women reaching 20 weeks gestation will have a stillborn baby. There is significant disparity in stillbirth rates within subgroups of the Australian population. Among Aboriginal and Torres Strait Islander (Indigenous) women, the stillbirth rate is one in every 93 women reaching 20 weeks gestation. Unfortunately, there has been no reduction in the national stillbirth rates over the past two decades and nearly a third are 'unexplained'. The ability to identify women at increased risk of stillbirth is an important and challenging priority. At present in Australia, there is a paucity of high quality data on causes and contributing factors to stillbirth. Furthermore, inconsistent approaches to investigation and classification affect the quality of data on causes of death and hamper the development of effective interventions to prevent stillbirth. AimsThe primary aim of this Thesis is to describe the epidemiology of stillbirth within the Australian context. This aim was addressed by: Examining trends in stillbirth by clinical classification of cause of death, Indigenous status and gestational age, to identify focal areas for preventive efforts  Assessing gestational age specific risk of stillbirth associated with four important contributors (diabetes, hypertension, antepartum haemorrhage and small-forgestational age) to higher stillbirth rates among Indigenous women in order to identify periods of increased risk  Developing and validating a statistical model to predict the risk of antepartum stillbirth at term (≥37 weeks) using maternal and pregnancy factors as a potential decision-making aid for clinicians and women  Assessing consistency in application of the Perinatal Society of Australia and New Zealand Perinatal Death Classification system between hospital committees and an independent expert panel, to identify areas for quality improvement  Determining maternal and pregnancy factors associated with parental consent to autopsy following stillbirth and explore parents' views and experiences of the autopsy consent process to inform clinical practice iii Methods and Results Data for 1995-2011 (n=881,211 singleton births) from the Queensland Perinatal DataCollection was analysed to address the first three aims. Stillbirth trends analysis found consistently higher rates of stillbirth among Indigenous women, however, the gap in stillbirth rates had narrowed. Gestational age specific stillbirth risk analysis found disparity in the magnitude of stillbirth risk for pre-existing diabetes and small-for-gestational age between Indigenous and non-Indigenous women. Despite strong association between maternal clinical factors and antepartum stillbirth risk, the prediction model had a poor ability to predict stillbirth risk at term.Consistency in application of the perinatal death classification system was assessed by calculating agreement. A substantial level of agreement was found between hospital committee and expert panel review of a cohort of 217 stillbirth cases, howeve...

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The role of fetal autopsy and placental examination in the causes of fetal death: a retrospective study of 132 cases of stillbirths

Abstract: Accurate fetal autopsy and placental examination related to meticulous clinical collecting data are requisites in the valuation of stillbirth and could play an important role in reduction of unexplained stillbirth rate.

Cited by 49 publications

References 54 publications

Foetal Autopsy-Categories and Causes of Death

Foetal Autopsy-Categories and Causes of Death

Pathologic Examination of Fetal and Placental Tissue Obtained by Dilation and Evacuation

Preventing stillbirths: Better data to inform interventions in Australia

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