Foetal and Perinatal Autopsy – A Study Of 100 Cases
Keywords:
Foetal autopsy, Perinatal autopsy, ReCoDe
Abstract
Background: Perinatal and foetal Autopsy pave way for bringing down these preventable stillbirths by identifying the potential areas where the health system tend to fail and helps to rule out congenital and infectious diseases and hence their recurrence. Aims: To describe and analyse the foetal and perinatal death. To determine how often the perinatal autopsy determines and confirms the cause of death and how often it changes the clinical diagnosis. Methods and Material: Autopsy was performed by the pathologist after obtaining informed written consent from parents, examining grossly and microscopically. The cause of death, whenever found was classified according to the ReCoDe system of classification of cause of death. Results: Cause of death was found in 101 (96.2%), unknown in 4 cases (3.8%). Foetal causes were found in 55 (52.4%), lethal Congenital Malformation was seen in 31 (29.5%) cases. Maternal causes were seen in 21 (20%), placental causes were seen in 11 (10.5%) cases. Other causes were attributed in 14 (13.3%) cases. Autopsy added significant findings to the prenatal diagnosis in 10 cases (10%) and changed and added new findings in (9%) 9 cases. While in (81%) 81 cases, it had confirmed the clinical diagnosis. Conclusions: Despite technological advancements, foetal autopsy remains gold standard for diagnosing the cause of death of foetus thus helping prenatal counselling.References
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11. Joshi VV, Bhakoo ON, Gopalan S, Gupta AN. Primary causes of perinatal mortality-autopsy study of 134 cases. Indian Journal of Medical Research 1979;69:963-71.
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18. Levi CS, Lyons EA, Martel MJ. Sonography of multifetal pregnancy. Diagnostic ultrasound. 2005;2:1207-9.
19. Hoyme HE, Higginbottom MC, Jones KL. Vascular etiology of disruptive structural defects in monozygotic twins. Pediatrics 1981;67:288-91.
20. Steffensen TS, Gilbert-Barness E, Spellacy W, Quintero RA. Placental pathology in trap sequence: clinical and pathogenetic implications. Fetal and pediatric pathology 2008;27:13-29.
21. Hall JG. Pena‐Shokeir phenotype (fetal akinesia deformation sequence) revisited. Birth Defects Research Part A. Clinical and Molecular Teratology 2009;85:677-94.
22. Vogt J, Morgan NV, Marton T, Maxwell S, Harrison BJ, Beeson D, et al. Germline mutation in DOK7 associated with fetal akinesia deformation sequence. Journal of medical genetics 2009;46:338-40.
23. Moessinger AC. Fetal akinesia deformation sequence: an animal model. Pediatrics 1983;72:857-63.
24. Rubin LG, Schaffner W. Care of the asplenic patient. New England Journal of Medicine 2014;371:349-56.
25. Shiraishi I, Ichikawa H. Human heterotaxy syndrome. Circulation Journal 2012;76:2066-75.
26. Burton EC, Olson M, Rooper L. Defects in laterality with emphasis on heterotaxy syndromes with asplenia and polysplenia: an autopsy case series at a single institution. Pediatric and Developmental Pathology 2014;17:250-64.
27. Pauli RM, Patterson JC, Arya S, Gilbert EF. Familial agnathia- holoprosencephaly. American Journal Medicine Genetics. 1983;14:677-98
28. Faye-Peterson O, David E, Rangwala N, et al. Otocephaly: Report of five new cases and a literature review. Fetal Pediatr Pathol. 2006; 25: 277-96.
29. Morris CD, Outcalt J, Menashe VD. Hyplastic left heart syndrome: natural history in a geographically defined population. Pediatrics 1990, 85(6):977- 983.
30. Grobman W, Pergament E. Isolated hypoplastic left heart syndrome in three siblings. Obstet Gynecol 1996;88:673-5.
2. Joseph R. Ophoven. Perinatal, fetal, and embryonic autopsy. In: Gilbert-Barness, editor. Potter's Pathology of the Fetus, Infant and Child, 2nd ed. Philadelphia: Mosby Elsevier; 2007. p. 695–08.
3. Boyd PA, Tondi F, Hicks NR, Chamberlain PF. Autopsy after termination of pregnancy for fetal anomaly: retrospective cohort study. bmj 2004;328:137.
4. Johns N, Al‐Salti W, Cox P, Kilby MD. A comparative study of prenatal ultrasound findings and post‐mortem examination in a tertiary referral centre. Prenatal diagnosis 2004;24:339-46.
5. Akgun H, Basbug M, Ozgun MT, Canoz O, Tokat F, Murat N, et al. Correlation between prenatal ultrasound and fetal autopsy findings in fetal anomalies terminated in the second trimester. Prenatal diagnosis 2007;27:457-62.
6. Sailer DN, Lesser KB, Harrel U, Rogers BB, Oyer CE. The clinical utility of the perinatal autopsy. Jama 1995;273:663-5.
7. Gardosi J, Kady SM, McGeown P, Francis A, Tonks A. Classification of stillbirth by relevant condition at death (ReCoDe): population based cohort study. Bmj 2005;331:1113-7.
8. Vergani P, Cozzolino S, Pozzi E, Cuttin MS, Greco M, Ornaghi S, et al. Identifying the causes of stillbirth: a comparison of four classification systems. American journal of obstetrics and gynecology 2008;199:319-e1.
9. World Health Organization. The WHO Application of ICD-10 to deaths during pregnancy, childbirth and the puerperium. In: The WHO Application of ICD-10 to deaths during pregnancy, childbirth and puerperium: ICD-MM. Geneva: WHO; 2012. p. 7.
10. Sankar VH, Phadke SR. Clinical utility of fetal autopsy and comparison with prenatal ultrasound findings. Journal of Perinatology 2006;26:224.
11. Joshi VV, Bhakoo ON, Gopalan S, Gupta AN. Primary causes of perinatal mortality-autopsy study of 134 cases. Indian Journal of Medical Research 1979;69:963-71.
12. Pradhan R, Mondal S, Adhya S, Raychaudhuri G. Perinatal autopsy: A study from India. Journal of Indian Academy of Forensic Medicine 2013;35:10-3.
13. Kaiser L, Vizer M, Arany A, Veszprémi B. Correlation of prenatal clinical findings with those observed in fetal autopsies: pathological approach. Prenatal diagnosis 2000;20:970-5.
14. Grover N. Congenital malformations in Shimla. The Indian Journal of Pediatrics 2000;67:249-51.
15. Tomatır AG, Demirhan H, Sorkun HC, Köksal A, Özerdem F, Cilengir N. Major congenital anomalies: a five-year retrospective regional study in Turkey. Genetics and Molecular Research 2009;8:19-27.
16. Mitchell SE, Reidy K, Costa FD, Palma-Dias R, Cade TJ, Umstad MP. Congenital Malformations Associated With a Single Umbilical Artery in Twin Pregnancies. Twin Research and Human Genetics 2015;18:595-600.
17. Gillim DL, Hendricks CH. Holoacardius: review of the literature and case report. Obstetrics & Gynecology 1953;2:647-53.
18. Levi CS, Lyons EA, Martel MJ. Sonography of multifetal pregnancy. Diagnostic ultrasound. 2005;2:1207-9.
19. Hoyme HE, Higginbottom MC, Jones KL. Vascular etiology of disruptive structural defects in monozygotic twins. Pediatrics 1981;67:288-91.
20. Steffensen TS, Gilbert-Barness E, Spellacy W, Quintero RA. Placental pathology in trap sequence: clinical and pathogenetic implications. Fetal and pediatric pathology 2008;27:13-29.
21. Hall JG. Pena‐Shokeir phenotype (fetal akinesia deformation sequence) revisited. Birth Defects Research Part A. Clinical and Molecular Teratology 2009;85:677-94.
22. Vogt J, Morgan NV, Marton T, Maxwell S, Harrison BJ, Beeson D, et al. Germline mutation in DOK7 associated with fetal akinesia deformation sequence. Journal of medical genetics 2009;46:338-40.
23. Moessinger AC. Fetal akinesia deformation sequence: an animal model. Pediatrics 1983;72:857-63.
24. Rubin LG, Schaffner W. Care of the asplenic patient. New England Journal of Medicine 2014;371:349-56.
25. Shiraishi I, Ichikawa H. Human heterotaxy syndrome. Circulation Journal 2012;76:2066-75.
26. Burton EC, Olson M, Rooper L. Defects in laterality with emphasis on heterotaxy syndromes with asplenia and polysplenia: an autopsy case series at a single institution. Pediatric and Developmental Pathology 2014;17:250-64.
27. Pauli RM, Patterson JC, Arya S, Gilbert EF. Familial agnathia- holoprosencephaly. American Journal Medicine Genetics. 1983;14:677-98
28. Faye-Peterson O, David E, Rangwala N, et al. Otocephaly: Report of five new cases and a literature review. Fetal Pediatr Pathol. 2006; 25: 277-96.
29. Morris CD, Outcalt J, Menashe VD. Hyplastic left heart syndrome: natural history in a geographically defined population. Pediatrics 1990, 85(6):977- 983.
30. Grobman W, Pergament E. Isolated hypoplastic left heart syndrome in three siblings. Obstet Gynecol 1996;88:673-5.
Published
2019-05-30
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