[37] Importance of Placental Availability When Correlating Clinical and Pathologic Cause of Death in Second and Third Trimester Fetal Deaths

C Pang, M Hernandez, J Tan, S Cerda, CD Sarita-Reyes. Boston Medical Center, Boston, MA

Background: It is known that the majority of second and third trimester fetal deaths are caused by a single or a combination of placental pathologies. This makes the use of placental examination an essential tool when determining fetal cause of death. However, 15 to 20 percent of stillbirths have no identifiable etiology.
Design: A retrospective study of 224 fetal autopsies performed at our Institution (Boston Medical Center) from 2000 to September 2009. Postmortem and placenta histology reports were reviewed. Gestational age, premortem clinical diagnosis, placental diagnosis, postmortem gross and histology findings, and final anatomic diagnosis were recorded.
Results: A total of 224 fetal autopsies were reviewed, of these, 197 (88%) of cases had placentas available for study, and 27 (12%) did not. One hundred and twenty-six (126) (56%) of cases had a placental cause of death (COD) (70% for 2^nd trimester (T) and 30% for 3^rd trimester (T) deaths).

Table 1

	Placentas Available	Placental COD	Other COD	No COD
Total (224)	197 (88%)	126 (56%)	42 (19%)	57 (25%)
2nd T (145)	132 (91%)	102 (70%)	23 (16%)	20 (14%)
3rd T (79)	65 (82%)	24 (30%)	19 (24%)	37 (47%)

Major placental causes were acute chorioamnionitis (ACA) with ascending amniotic-fluid infection (65 of 2^nd T and 5 of 3^rd T), and placental vascular disease/placental abruption (PVD) (30 of 2^nd T and 14 of 3^rd T). Umbilical cord (UC), twin to twin transfusion (TTT) and congenital malformations (M) (16 of 2^nd T and 11 of 3^rd T) were also recorded. No cause (NC) of fetal death was found in 20 of 2^nd T and 37 of 3^rd T cases. Of the 27 (12%) cases with no available placenta for study, 20 (14 of 2nd T and 6 of 3^rd T) had a known cause of death due to congenital malformations (12), other causes were amniotic ascending infection (3), and other (5). Seven (7) cases had no postmortem known cause of death.

Table 2

	ACA	PVD	UC	TTT	M	O	NC
2nd T	65	30	2	7	16	5	20
3rd T	5	14	4	1	11	7	37

Conclusions: Placental examination is a key factor in the evaluation of cause of fetal death, however, a complete autopsy report can be generated with sufficient clinical history and histologic evaluation of fetal organs. In our study, placental examination provided the lead diagnosis in the majority (56%) of cases with the support of organ histology. Only 26% (7 of 27) cases with no placenta available for study remained with no postmortem cause of death (2 of 2^nd trimester and 5 of 3^rd trimester fetal deaths).
Category: Autopsy

Wednesday, March 24, 2010 9:30 AM

Poster Session V # 22, Wednesday Morning