title: Fetal foot length at delivery as a tool for determining gestation length in non-macerated stillbirths.
abstract: OBJECTIVE
  To assess whether fetal foot length at autopsy could reliably indicate gestation duration at stillbirth and the effects of maceration on this method.
  
  
  METHODS
  The present cross-sectional secondary analysis was part of the Safe Passage Study; all Safe Passage Study participants who experienced a stillbirth at Tygerberg Academic Hospital, Cape Town, South Africa, between August 1, 2007, and January 31, 2015, were eligible to participate. After providing written informed consent for autopsy, the duration of gestation calculated using early ultrasonography and fetal foot length were compared.
  
  
  RESULTS
  There were 69 fetal autopsies included in the present study; placental histology was available for 65. Generally, the gestation length calculated from the first ultrasonography scan correlated well with that calculated from the fetal foot length (Spearman correlation=0.85). However, significant differences were found in the gestation lengths calculated when the fetus was macerated (P<0.001), or when umbilical cord pathology (P<0.001) or maternal vascular malperfusion (P<0.001) was the cause of fetal death.
  
  
  CONCLUSIONS
  Foot length at stillbirth was a good indicator of gestation length; however, it was a weaker indicator if fetal maceration had occurred.
authors.affiliation: Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa.
authors.forename: Elaine
authors.initials: E
authors.lastname: Geldenhuys
authors.affiliation: Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa.
authors.forename: Jean
authors.initials: J
authors.lastname: Coldrey
authors.affiliation: Division of Anatomical Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa.|Lancet Laboratories, Johannesburg, South Africa.
authors.forename: Colleen
authors.initials: C
authors.lastname: Wright
authors.affiliation: Department of Statistics and Actuarial Science, Stellenbosch University, Stellenbosch, South Africa.
authors.forename: Daan
authors.initials: D
authors.lastname: Nel
authors.affiliation: Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Drucilla J
authors.initials: DJ
authors.lastname: Roberts
authors.affiliation: Department of Pathology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Theonia K
authors.initials: TK
authors.lastname: Boyd
authors.affiliation: Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa.
authors.forename: Hein
authors.initials: H
authors.lastname: Odendaal
mesh_terms: D000293:Adolescent; D000328:Adult; D001344:Autopsy; D001837:Body Weights and Measures; D003430:Cross-Sectional Studies; D005260:Female; D005333:Fetus / Q000000981:diagnostic imaging* / Q000473:pathology; D005528:Foot / Q000000981:diagnostic imaging* / Q000473:pathology; D005865:Gestational Age; D006801:Humans; D008297:Male; D011247:Pregnancy; D050497:Stillbirth; D016216:Ultrasonography, Prenatal; D055815:Young Adult
keywords: Fetal growth; Foot length; Gestational age; Macerated stillbirth; Maternal vascular malperfusion; Umbilical cord pathology