title: Assessment of "fresh" versus "macerated" as accurate markers of time since intrauterine fetal demise in low-income countries.
abstract: OBJECTIVE
  To compare provider assessment of fetal maceration with death-to-delivery interval to evaluate the reliability of appearance as a proxy for time of death.
  
  
  METHODS
  Cohort chart abstraction was performed for all stillbirth deliveries at or above 28 weeks of gestation during a 1-year period in a teaching hospital in Ghana.
  
  
  RESULTS
  Of 470 stillborn infants, 337 had adequate data for analysis. Of 47 fetuses alive on admission with death-to-delivery intervals estimated to be less than 8 hours (expected to be reported as fresh), 14 (30%) were actually reported as macerated. Of 94 cases in which the fetus was deceased on admission with death-to-delivery interval of more than 8 hours (expected to be macerated), 17 (18%) were described as fresh.
  
  
  CONCLUSIONS
  Provider description of fetal appearance may be an unreliable indicator for time since fetal death. The findings have significant implications for stillbirth prevention and assessment.
authors.affiliation: Department of Family Medicine, University of Michigan, Ann Arbor, USA; Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, USA. Electronic address: ktgold@umich.edu.
authors.forename: Katherine J
authors.initials: KJ
authors.lastname: Gold
authors.affiliation: Department of Obstetrics and Gynaecology, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Komfo Anokye Teaching Hospital, Kumasi, Ghana.
authors.forename: Abdul-Razak S
authors.initials: AR
authors.lastname: Abdul-Mumin
authors.affiliation: Department of Family Medicine, University of Michigan, Ann Arbor, USA.
authors.forename: Martha E
authors.initials: ME
authors.lastname: Boggs
authors.affiliation: Department of Obstetrics and Gynaecology, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Komfo Anokye Teaching Hospital, Kumasi, Ghana.
authors.forename: Henry S
authors.initials: HS
authors.lastname: Opare-Addo
authors.affiliation: Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, USA; Department of Pathology, University of Michigan, Ann Arbor, USA.
authors.forename: Richard W
authors.initials: RW
authors.lastname: Lieberman
mesh_terms: D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D036861:Delivery, Obstetric / Q000706:statistics & numerical data*; D005260:Female; D005313:Fetal Death; D005333:Fetus / Q000473:pathology*; D005869:Ghana; D006784:Hospitals, Teaching; D006801:Humans; D008875:Middle Aged; D011247:Pregnancy; D015203:Reproducibility of Results; D050497:Stillbirth / Q000453:epidemiology*; D013997:Time Factors; D055815:Young Adult
keywords: Fetal death; Fetal pathology; Ghana; Low-income country; Maceration; Stillbirth; Sub-Saharan Africa