The Importance of Placental Examination in Stillborn and Neonatal Autopsies.
Asif S Shahab, Haitham Nassar, Yasin Ahmed, Paul J Kowalski. St. John Hospital and Medical Center, Detroit, MI
Background: Fetal death is quite a devastating loss to families. Many fetal deaths are unidentifiable. Perhaps gross and microscopic examination of the placenta can play a more crucial role in the understanding the etiology of fetal demise in such cases. Consequently, the pathologist can bring some closure to these families.
Design: A retrospective cohort study concerning all stillbirth and neonatal autopsies over a period of 10 years (January 2000-January 2010). We selected only cases with corresponding placentas.
Results: There were 88 autopsies satisfying all criteria, 65 still borns and 23 liveborns. We first reviewed the diagnostic findings of the autopsies which were grouped into two categories: A diagnostic category which includes 33 cases (37.5%) with pertinent gross anomalies involving mainly brain, heart, lungs, or kidneys and findings consistent with fetal stress and prematurity, such as renal and adrenal hemorrhages, hyaline membrane disease, or intracranial hemorrhage. The second includes nondiagnostic category of 55 cases (62.5%) showing either normal findings or advanced autolysis. By correlating the corresponding placentas, it was determined that 62 cases (70.5%) had pertinent findings like chorioamnionitis or abruption and retroplacental hematomas. This important correlation of autopsy and placental examination significantly increased the diagnostic yield from 37.5% to 70.5%.
Conclusions: Even though the autopsy is a key diagnostic tool in unexplained fetal demise and neonatal deaths, our study illustrates the importance of correlating placental examination along with the autopsy findings. It proves that it can enhance the pathologist's diagnostic ability in these cases.
Wednesday, March 2, 2011 9:30 AM
Poster Session V # 2, Wednesday Morning