Identification of the causes of intrauterine death during 310 consecutive autopsies.
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 191 cases (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.
Horn
Lars-Christian
LC
Institute of Pathology, University Hospital of Leipzig, Liebigstrasse 26, Leipzig D-04103, Germany. hornl@medizin.uni-leipzig.de
Langner
Andrea
A
Stiehl
Peter
P
Wittekind
Christian
C
Faber
Renaldo
R
D001344:Autopsy; D000013:Congenital Abnormalities / Q000453:epidemiology; D005260:Female; D005313:Fetal Death / Q000209:etiology* / Q000473:pathology; D005317:Fetal Growth Retardation / Q000453:epidemiology; D020567:Fetal Weight; D005865:Gestational Age; D006801:Humans; D010922:Placenta Diseases / Q000150:complications / Q000453:epidemiology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology; D011272:Pregnancy, Multiple; D014470:Umbilical Cord / Q000473:pathology; D014591:Uterine Diseases / Q000150:complications / Q000453:epidemiology