Impact of Intrauterine Retention on Determining Cause of Death in Stillborns.
Rong Li, Ona M Faye-Petersen, Michael P Steinkampf, Stephanie D Reilly. University of Alabama at Birmingham; Alabama Fertility Specialists, Birmingham
Background: Intrauterine fetal demise is an emotionally devastating event for women and their doctors. The perinatal autopsy is an important tool in determining the cause of fetal death (COD). Either expectant management or induction of labor is considered an appropriate option under these circumstances, but how the choice of patient management affects the accuracy of the autopsy is not known. The purpose of this study was to evaluate the effect of intrauterine retention (IUR) on pathologists' abilities to determine COD from the perinatal autopsy.
Design: This was a review of all cases of stillbirth (≥20 wk gestational age) submitted for autopsy at a tertiary care university hospital between 1/1/1992 and 5/5/2010. COD was determined by clinical history, additional laboratory testing as indicated, and autopsy findings of the fetus and placenta. The interval between fetal demise and delivery was determined both by history and by evaluating the characteristic histologic changes in fetal organs and placenta according to the criteria of Genest and colleagues (ObstetGynecol.1992;80:575-592). Statistical analyses were performed using contingency table analysis and parametric or nonparametric analysis of variance as appropriate.
Results: A total of 404 cases were reviewed. A placenta was submitted in 92% of cases. The mean maternal age was 24.4 yr (range 14 to 44 yr). The stated maternal race was Asian 1%, Black 68%, Hispanic 4%, White 27%. The mean gestational age at demise was 29.9 weeks (range 20 to 43 weeks). A vaginal delivery was performed in 96% of cases. Fetal sex was male in 55% of cases and undetermined in 1 case. No COD could be determined in 22% of cases. The IUR period was specified in all but one autopsy report, with a mean of 5.9 days (range 1 to 112 days, median 2.25 days). The mean IUR time in cases with determinations of COD was 4.0 days, compared to 12.4 days in cases for which no COD could be determined (P<0.0001). A COD could be determined in 89% of cases in which IUR time was less than 7 days, but in only 46% of cases with IUR time ≥7days (P<0.0001). The differences persisted when cases of placental abruption, acute chorioamnionitis, or intrapartum demise were excluded from the analysis.
Conclusions: Prolonged intrauterine retention (≥7d) after fetal demise is associated with decreased ability to identify the cause of death.
Monday, February 28, 2011 9:30 AM
Poster Session I Stowell-Orbison/Surgical Pathology/Autopsy Awards Poster Session # 5, Monday Morning