Contribution of Perinatal Autopsy to the Assessment of Intrauterine Fetal Demise
OL Bohn, T Lertsburapa, JF Tomashefski, Jr, J Sawady. MetroHealth Medical Center-Case Western Reserve University, Cleveland, OH
Background: Fetal autopsy is one of the tools available for the determination of the cause of intrauterine fetal death (IUFD). The purpose of this study was to evaluate the contribution of perinatal autopsy in the assessment of the cause of IUFD.
Design: Perinatal autopsies performed at MHMC from January 2002 to December 2007 were reviewed. The causes of death as determined by perinatal autopsy were compared with the available clinical information.
Results: Among all 619 autopsies performed from 2002 to 2007, 95 (15.3%) were perinatal. The male/female ratio was 1:1. The mean gestational age was 27.7 weeks, ranging from 16 to 42 weeks. Chromosomal abnormalities were found in four cases (4.2 %) including trisomy 21 (2), trisomy 18 (1) and 46, XY der(17) t(8:17) (1). Osteogenesis imperfecta and twin to twin transfusion syndrome were found in two cases. The remaining cases showed isolated anomalies including bilateral renal agenesis, bilateral club feet, cleft palate, esophageal atresia, hypoplasia of fingers and hypoplasia of right testicle, without associated chromosomal abnormalities. Examination of the placenta revealed acute chorioamnionitis in 50 cases (52.6%), abruptio placentae (12) and placental infarcts (10). Microbiological cultures from fetal organs and placenta were positive for Group B-Streptococcus (15 cases), Enterococcus (2) and Escherichia coli (1). Umbilical cord prolapse was observed clinically in two cases. Maternal factors contributing to IUFD included premature rupture of membranes (8 cases), cervical incompetence (6), pre-eclampsia (5), Hepatitis B (1) and HIV (1) infections, cocaine abuse (1) and antiphospholipid syndrome (1). In sixteen cases (16.8%) the cause of death could not be determined. Autopsy findings, including cytogenetics and microbiological cultures established the cause of IUFD in 83.2% of cases (79/95).
Conclusions: Perinatal autopsy along with placental examination, cytogenetic studies and bacteriological cultures proved to be a valuable tool in the determination of the cause of IUFD in the majority of our cases (83.2%). It is recommended that permission for autopsy should be strongly encouraged in cases of IUFD.
Wednesday, March 24, 2010 9:30 AM
Poster Session V # 23, Wednesday Morning