The Impact of Placental Examination in the Autopsy of the Structurally Normal Stillborn
X Wu, OM Faye-Petersen, JL Steinkampf, TJ Richardson, SD Reilly. UAB, Birmingham, AL
Background: Stillbirth of an apparently normal fetus is an emotionally devastating event for both patients and clinicians. Identifying the cause of death (COD) in these cases not only brings emotional closure but may also help with future pregnancy planning. Placental examination is recognized as an important component of the fetal autopsy. We wished to compare the rates of determination of COD in structurally normal stillborns at our institution prior to and after the placental examination was made a requisite component of the perinatal autopsy protocol.
Design: Prior to 1992, fetal autopsies at our institution did not routinely include the placenta. In 1992, a departmental policy was instituted strongly recommending that the placenta be submitted on all perinatal cases. We reviewed our autopsy records from 01/01/1987 through 12/31/2007 to assess the impact of this policy on the ability of postmortem examination to determine the COD in cases of stillbirth and to evaluate the contribution of the placental examination in these cases. Cases with congenital abnormalities were excluded from the study to minimize confounding factors. The autopsies with placental examinations were categorized by whether the evaluation of the placenta provided confirmatory evidence concerning the COD; provided new information and COD; or did not provide additional information regarding the COD.
Results: During the 21-year period examined, 458 stillborn autopsies were performed; 388 of these autopsies revealed structurally normal fetuses (84.7%). Of the structurally normal fetal autopsies, 94 cases (24%) were performed prior to the policy institution and 294 after. Comparing the frequency of placental examination and COD determination before and after the policy (1992), we demonstrated that the percentage of placental examinations increased from 42.25.3 % (1987-1991) to 92.12.1 % (1992-2007), and the frequency of COD determination increased from 38.57 % to 79.53.2 % (P=<0.0001). The placental examination provided confirmatory evidence in 24.6 %, new diagnostic information and COD in 44.7 % and no additional information in 30.7 %. However, in those that did not yield any additional information, COD was identified from the clinical history in 27 % and in the remainder, several common causes of intrauterine demise, such as intrauterine infection or villitis of unknown etiology, were excluded.
Conclusions: The cause of death in structurally normal intrauterine fetal demise cases is more likely to be identified if routine pathologic examination of the placenta is performed.
Monday, March 9, 2009 9:30 AM
Poster Session I Stowell-Orbison/Autopsy Award # 12, Monday Morning