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Fatima R, Karamchedu S, B.V H, Jana T, K S, K F N. Role of fetal autopsy and its importance in intrauterine fetal death: Histopathological diagnosis. Journal of Research in Applied and Basic Medical Sciences 2023; 9 (4) :233-242
URL: http://ijrabms.umsu.ac.ir/article-1-256-en.html
Associate professor, Department of Pathology, SVS Medical College and Hospital, Yenugonda, Mahabubnagar, Telangana-509001, India , dr.kshilpa@rediffmail.com
Abstract:   (186 Views)
Background & Aims:  Intrauterine fetal death (IUFD)/stillbirth accounts for a significant portion of perinatal mortality and is thus a good indicator of healthcare system quality. Autopsy is a well-known specialized surgical procedure used to determine the cause of death. The study's goal is to learn the cause of death, the prevalence of congenital anomalies, and to confirm the diagnosis histopathologically.
Materials & Methods:  The study included 32 cases of all terminated pregnancies from 12 to 38 weeks due to abnormal prenatal findings and IUFDs received for autopsy in the department of pathology over a four-year period from 2018 to 2022. Autopsies were carried out in accordance with standard protocol, and included external and internal examinations with photography, as well as gross and microscopic examinations of various organs and the placenta.
Results:  Over a four-year period, Abnormalities detected via autopsy are 32 (80%) out of 40 cases, whereas ultrasound findings detected about 11(27.5%) out of 40 cases. Thus, autopsy added to the diagnosis about 47.5%. External anomalies noted in 9 cases and internal anomalies noted in 14 cases. Gestational age of fetuses in intrauterine deaths in our study is early deaths (55%). The most common cause of death was fetal causes (37.5%), followed by placental causes (35%) and two amniotic fluid causes (5%). In congenital causes central nervous system anomalies [(6 cases) which include Arnold Chiari malformation (2 cases), Potter syndrome (1 case), hydrocephalus (3 cases)] were the most common followed by cardiovascular system malformations [(4 cases) which include VSD (2 cases), dextrocardia (1 case), hypoplastic left heart syndrome (1)]. Placental lesions were present in 14 (27.5%) of the cases.
Conclusion:  The most common cause of death was congenital anomalies. Though the number of perinatal autopsies has decreased in recent years, fetal autopsies continue to play an important role in determining the cause of disease. It is considered the gold standard for diagnosis, giving parents hope for the future.
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1. Fatima U, Sherwani R, Khan T, Zaheer S. Foetal autopsy-categories and causes of death. J Clin Diagn Res 2014;8(10):FC05. [DOI:10.7860/JCDR/2014/9226.4920] [PMID] []
2. College of American Pathologists Pamphlet. Autopsy: aiding the living by understanding death. Northfield: College of American Pathologist (CAP); 2001. [URL]
3. National Center for Health Statistics (US). State definitions and reporting requirements for live births, fetal deaths, and induced terminations of pregnancy. US Department of Health and Human Services, Public Health Service, Office of Health Research, Statistics and Technology, National Center for Health Statistics; 1981. [URL]
4. Sharma L. Autopsy in Foetal Infant Deaths. InCriminology and Post-Mortem Studies-Analyzing Criminal Behaviour and Making Medical Decisions 2020 Jun 9. http://dx.doi.org/10.5772/intechopen.92673 [DOI:10.5772/intechopen.92673]
5. Liu L, Johnson HL, Cousens S, Perin J, Scott S, Lawn JE, et al. Global, regional, and national causes of child mortality: an updated systematic analysis for 2010 with time trends since 2000. Lancet 2012;379(9832):2151-61. [DOI:10.1016/S0140-6736(12)60560-1] [PMID]
6. Tiwari P, Gupta MM. Study of lethal congenital malformations at a tertiary-care referral centre in North India. Cureus 2020;12(4). [DOI:10.7759/cureus.7502]
7. Cunningham FG, Hollier LM. Fetal Death. Williams Obstetrics. 20th edn (suppl 4) Norwalk Ct. Appleteon & Lange. 1997. [URL]
8. Lyon A. Perinatal autopsy remains the "gold standard". Arch Dis Child Fetal Neonatal Ed 2004;89(4):F284. doi: 10.1136/adc.2003.037333. [DOI:10.1136/adc.2003.037333] [PMID] []
9. Petersson K, Bremme K, Bottinga R, Hofsjö A, Hulthén-Varli I, Kublickas M, et al. Diagnostic evaluation of intrauterine fetal deaths in Stockholm 1998-99. Acta Obstet Gynecol Scand. 2002;81:284-92. [DOI:10.1034/j.1600-0412.2002.810402.x] [PMID]
10. Fretts RC. Etiology and prevention of stillbirth. Am J Obstet Gynecol 2005.193:1923-35. [DOI:10.1016/j.ajog.2005.03.074] [PMID]
11. Cnattingius S, Stephansson O. The epidemiology of stillbirth. Semin Perinatol 2002;26:25-30. [DOI:10.1053/sper.2002.29841] [PMID]
12. Huang DY, Usher RH, Kramer MS, Yang H, Morin L, Fretts RC. Determinants of unexplained antepartum fetal deaths. Obstet Gynecol 2000.95:215-221. [DOI:10.1097/00006250-200002000-00009] [PMID]
13. Tang MY, Zhu YN, Xu H, et al. Clinicopathological analysis of causes of perinatal death. Chin Med J (Engl) 1989;102:672-8. [Google Scholar]
14. Laing IA. Clinical aspects of neonatal death and autopsy. Semin Neonatol 2004;9:247-54. [DOI:10.1016/j.siny.2003.11.004] [PMID]
15. Faye-Petersen OM, Guinn DA, Wenstrom KD. The value of perinatal Autopsy. Obstel Gynecol 1999;94(6):915-20. [DOI:10.1097/00006250-199912000-00003] [PMID]
16. Pasztor N, Kereszturi A, Kozinzky Z, Pal A. Identification of causes of stillbirth through autopsy and placental examination reports. Fetal Pediatr Pathol 2014;33(1):49-54. [DOI:10.3109/15513815.2013.850132] [PMID]
17. Davies BR, Arroyo P. The importance of primary diagnosis in perinatal death. Am J Obstet Gynecol 1985;152:17-23. [DOI:10.1016/S0002-9378(85)80168-X] [PMID]
18. Thakur S, Kadam K, Paliwal P, Singh S, Singh C, Kapoor S, et al. Comprehensive Postmortem Evaluation of Intrauterine Fetal Deaths and Stillbirths. Perinatology 2022:22(4);237-44. [Google Scholar]
19. Fatima U, Sherwani R, Khan T, Zaheer S. Foetal autopsy-categories and causes of death. J Clin Diagn Res 2014;8(10):FC05-8. [DOI:10.7860/JCDR/2014/9226.4920] [PMID] []
20. Shankar VH, Phadke SR. Clinical utility of fetal autopsy and comparison with prenatal ultrasound findings. J Perinatol 2006;26:224-29. [DOI:10.1038/sj.jp.7211482] [PMID]
21. Benirschke K, Kaufman P. Pathology of the Human Placenta. 4th ed, Springerverlag,2000. [DOI:10.1007/978-1-4757-4199-5]
22. Leizel AE. Primary prevention of birth defects by preconceptional care including multivitamin supplementation (review). Bacillieres Chin Obstel Gynecol 1995;9:417-21. [DOI:10.1016/S0950-3552(05)80372-4] [PMID]
23. Allessandri LM, Stanley FJ, Garner JB, Newham J, Wlaters BNJ. A case- control study of unexplained antepartum stillbirths. Br J Obstet Gynecol 1992;99(9):711-18. [DOI:10.1111/j.1471-0528.1992.tb13869.x] [PMID]
24. Shepard TH, Fantel AG, Fitzsimmons J. Congenital defect rates among spontaneous abortuses: twenty years of monitoring. Teratology 1989;39:325-31. [DOI:10.1002/tera.1420390404] [PMID]
25. Heazel AE, Martindale EA. Can post-mortem examination of the placenta help to determine the cause of stillbirth? J Obstet Gynecol. 2009;29:225-228. [DOI:10.1080/01443610802716042] [PMID]
26. Bastianelli C, Carrara S, Filippi V, Rapiti S, Ripani AE, Farris M (2007) Stillbirths: experience in an Italian third level centre. Minerva Ginecol 59(5):505-511. [Google Scholar]
27. Marchetti D, Belviso M, Fulcheri E. A case of stillbirth: the importance of placental investigation in medico-legal practice. Am J Forensic Med Pathol 2009;30(1):64-8. ttps://doi.org/10.1097/PAF.0b013e318187387e [DOI:10.1097/PAF.0b013e318187387e] [PMID]
28. Bonetti LR, Ferrari P, Trani N, Maccio L, Laura S, Giuliana S, Facchinetti F, Rivasi F. The role of fetal autopsy and placental examination in the causes of fetal death: a retrospective study of 132 cases of stillbirths. Arch Gynecol Obstet 2011;283(2):231-41. [DOI:10.1007/s00404-009-1317-4] [PMID]
29. Machin GA. Hydrops revisited: literature review of 1,414 cases published in the 1980s. Am J Med Genetics 1989;34:366-90. [DOI:10.1002/ajmg.1320340313] [PMID]
30. Pekkola M, Tikkanen M, Loukovaara M, Lohi J, Paavonen J, Stefanovic V. Postmortem examination protocol and systematic re-evaluation reduce the proportion of unexplained stillbirths. J Perinatal Med 2020 Oct 25;48(8):771-7. [DOI:10.1515/jpm-2019-0426] [PMID]
31. Kulkarni AD, Palaniappan N, Evans MJ. Placental Pathology and Stillbirth: A review of the literature and guidelines for the less experienced. J Fetal Med 2017;4(4):177-85. [DOI:10.1007/s40556-017-0133-3]

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