Comprehensive Postmortem Evaluation of Intrauterine Fetal Deaths and Stillbirths

Seema Thakur, Khushboo Kadam, Preeti Paliwal, Shubhnita Singh, Chanchal Singh, Sunita Kapoor, Deepa Khurana

Abstract

Background: Conducting a postmortem examination of a fetus following spontaneous or missed miscarriage (intrauterine fetal death [IUFD]) in the second trimester could provide a complete or partial explanation for the pregnancy loss.

Aim: To conduct postmortem evaluation of fetuses to identify the etiologic factors that might have contributed to IUFD or that might be indicative of other factors that play a significant role in IUFD

Materials and Methods: A total of 100 consecutive cases of IUFDs were considered (from January 2010 to May 2019) for etiologic diagnosis. The procedure was conducted according to the standard protocol and involved external examination, dysmorphological examination, internal examination, and full-body anteroposterior and lateral radiographic analyses. Histopathologic analysis of the placenta was also done. The fetuses were also subjected to genetic testing such as fluorescence in situ hybridization and microarray. A clinical correlation was done by an obstetrician–geneticist to reach an etiologic diagnosis.

Results: Two-thirds of the IUFD cases occurred after 30 weeks of gestation. Of the 100 cases, 24 had fetal anomalies, and genetic causes were present in 12.9% of the cases. It was observed that 68.6% of the cases were associated with pathology of the placenta; 30% of the cases were associated with cord lesions; and the results were inconclusive in 14% of the cases.

Conclusions: In this study, we attempted to establish the etiologic diagnosis of IUFDs and understand the contribution of each test in finding the cause of the IUFD. This will help obstetricians in counseling parents regarding the benefits of postmortem examination of a fetus that had an IUFD, and thus, be better able to guide the parents about future recurrence risk and management.