Intra-Uterine Fetal Demise: Autopsy and Clinical Findings amongst Different Age Groups in an Inner City Hospital
Matea Deliu, Mario I Mosunjac, Marina B Mosunjac. Emory University, Atlanta, GA
Background: Stillbirth occurs in 1% of all pregnancies in the USA and remains largely unstudied. The use of fetal autopsy has been limited in many institutions by cost, a lack of trained pathologists, and discomfort on the part of physicians and patients in discussing or having the procedure. Here we report on clinico-pathologic characteristics between different age groups in an inner city hospital.
Design: A retrospective search (2002-11) was performed to identify all women (n=163) who were diagnosed with intrauterine fetal demise in an inner city hospital. The findings were compared in three age groups: 1) under 21 (n=37), 2) 21-34 (n=104), 3) >35 (n=22). Fetal autopsy results, which included gross and microscopic morphology, were reviewed and demographic data was obtained from electronic patient charts.
Results: Under-21 stillbirths represent 23% of total stillbirths in an inner city hospital with a large racial distribution: 92% of under 21 were African American while significantly lower in >35 (54%). Gestational ages, however, were similar in all three groups. Lack of prenatal care and STD's were the most common maternal factors in the under 21s, while diabetes, pre-eclampsia/hypertension, and previous abortions prevailed in the other age categories. Chorioretinitis was the main placental factor in all groups, followed by placental infarction in groups 1 and 2, and retroplacental hematoma in group 3. Overall, no real significant differences in the cause of death were identified, with placental causes predominating.
Conclusions: Our autopsy findings do not reveal any significant differences in gestational age, placental factors, or cause of death among the three age groups. However, compared to the over-21 groups, younger patients are more prone to receiving inadequate prenatal care and have a higher incidence of STD's. Thus, not only are these females devoid of prenatal care, but most are also of low socioeconomic status, and lacking in health insurance. This ultimately places them in a high-risk population group representing a significant portion of diagnosed stillbirths. Further collaborative studies in this age range should be conducted in order to attempt to educate these young women on STD's and importance of prenatal care.
Wednesday, March 6, 2013 9:30 AM
Poster Session V # 3, Wednesday Morning