title: Elevated brain weight/liver weight ratio in normal body weight centile term perinatal deaths: an indicator of terminal intrauterine malnourishment.
abstract: A proportion of antepartum/intrapartum intrauterine deaths (IUDs) with normal or elevated body weight (BW) centile also show an elevated brain weight/liver weight (BLR) ratio. We postulate that this may be an indication of intrauterine malnourishment/incipient intrauterine growth restriction (IUGR), which may have a bearing on the cause of death. Searching our departmental postmortem database, we identified 331 IUD/intrapartum deaths (254; 77%) or early neonatal deaths (77; 23%), ≥37/40 weeks gestation in a 4-year period. The customized BW centile, BLR, brain weight/thymus weight ratio (BTR), fetus weight/placenta weight ratio (FPR), and maternal body mass index were calculated. A BLR >4.0 and a BTR >60 were regarded as abnormal. Of the 331 cases, the BLR was >4.0 in 71 (21.4%). Nineteen (26.7%) of the 71 had a BW above the 25th centile, and these were all IUDs. Eight deaths were explained. In the 11 unexplained deaths, the BTR was raised in 5 and FPR was elevated in 7. Three of these 11 mothers had impaired glucose tolerance, and 7 were overweight or obese. In the absence of a definitive cause, a raised BLR in an IUD with a normal BW centile is likely to indicate nutritional impairment/incipient IUGR. The majority of these deaths are associated with maternal obesity, with or without impaired glucose tolerance. Recognition of features of IUGR in IUDs of normal BW may help us understand the death. In these cases, placental growth may be insufficient to support a macrosomic fetus, leading to late nutritional impairment and death.
authors.affiliation: Department of Cellular Pathology, Birmingham Women's Hospital, Mindelsohn Way, Birmingham, B15 2TG, UK. tamas.marton@bwhct.nhs.uk
authors.forename: Tamas
authors.initials: T
authors.lastname: Marton
authors.forename: Beata
authors.initials: B
authors.lastname: Hargitai
authors.forename: Clare
authors.initials: C
authors.lastname: Bowen
authors.forename: Phillip M
authors.initials: PM
authors.lastname: Cox
mesh_terms: D001835:Body Weight; D001921:Brain / Q000473:pathology*; D005260:Female; D005313:Fetal Death / Q000473:pathology*; D005317:Fetal Growth Retardation / Q000473:pathology*; D006801:Humans; D008099:Liver / Q000473:pathology*; D009929:Organ Size; D011247:Pregnancy; D012189:Retrospective Studies; D050497:Stillbirth