Identification of the causes of intrauterine death during 310 consecutive autopsies

Abstract

Objective: Evaluation of causes of death in stillborn infants. Methods: During a five-year period, 310 consecutive autopsies of stillborn infants were performed using a standardized protocol with systematic examination of all major cranial, thoracic and abdominal organs including microscopic examination. Results: In 71%, the intrauterine death (ID) occurred up to the end of the 37th week of gestation. Thirty-seven percent (115/310) stillbirths represented with maceration and about one-half with minor or major malformations. Thirty-one percent (53/171) of them were responsible for intrauterine death. In 83% (44/53), the intrauterine death of the malformed fetus occurred before the end of 37th week of gestation, most of them (48/53, 90.6%) were small for gestational age infants. In 75.5% (234/310), the placental villous tree and the umbilical cord represented pathologic conditions. In 191cases (61.1%), utero-placental pathology was responsible for intrauterine death. Intrauterine infections and traumatic lesions were accompanied by intrauterine death in 2.2 and 1.3%, respectively. In 15.2%, unexplained intrauterine death (because of severe maceration, the placenta was not available for autopsy or insufficient clinical data) occurred. Conclusions: Perinatal autopsy may be valuable in three ways: the confirmation of ante-mortem diagnoses; the identification of unexpected disorders; and exclusion of other (perhaps inheritable) conditions which might be have caused the intrauterine death. Clinically valuable information, obtained from the autopsy, can be improved by high autopsy rate and performing perinatal necropsies by specially trained pathologists.

Introduction

The loss of a pregnancy is a common problem and perinatal death complicates about 1.5% of all births [1]. Pregnancy failure is often difficult for patients and their families to understand and accept and may provoke self-recrimination and criticism of the physician. Once a couple has experienced a fetal demise or neonatal death, they are likely to have serious concerns about their recurrence risks.

A perinatal autopsy can provide explanations for pregnancy loss, often relieving the patient and their physician of blame and may reveal a specific disorder for which precise recurrence risks or strategies for prevention are available [2], [3], as has been shown for cases with induced abortions [4].

Additionally, the autopsy gives new information regarding the sickness and represent one instrument of quality control in medical care [5]. The present study represents the results of perinatal autopsies of more than 300 consecutive stillborn infants.