Macerated Stillbirth

  • Isabella E. Moore


Despite the increasing accuracy of prenatal detection of birth defects and genetic disorders, necropsy still provides the final diagnosis in many cases and serve as an “ultimate audit”. In Berger’s view (1978) “any single autopsy may not have dramatic import for progress in medicine, but it may have profound and lifelong implications for helping the dead child’s family”. Necropsy results are of great importance to the parents of stillborn infants. However, the task of autopsy on a macerated stillbirth is too often delegated to the least experienced trainee.


Obstet Gynecol Congenital Heart Block Periventricular Leukomalacia Intrauterine Death Acta Obstet Gynecol 
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  1. Abdella TN, Sabai BM, Hays JM, Anderson GD (1984) Relationship of hypertensive disease to abruptio placentae. Obstet Gynecol 63:365–370PubMedGoogle Scholar
  2. Alberman ED, Creasy MR (1977) Frequency of chromosomal abnormalities in miscarriages and perinatal deaths. J Med Genet 14: 313–315PubMedCrossRefGoogle Scholar
  3. Becker MJ, Becker AE (1976) Fat distribution in the adrenal cortex as an indication of the mode of intrauterine death. Hum Pathol 7: 495–504PubMedCrossRefGoogle Scholar
  4. Benirschke K, Driscoll SG (1967) The pathology of the human placenta. Springer, Berlin Heidelberg New YorkGoogle Scholar
  5. Berger LR (1978) Requesting the autopsy. A pediatric perspective. Clin Pediatr 17: 445–452CrossRefGoogle Scholar
  6. Bose C (1978). Hydrops fetalis and in utero intracranial hemorrhage. J Pediatr 93: 1023–1024PubMedCrossRefGoogle Scholar
  7. Brandt CA, Holmskov A (1990) The prevalence of prenatal death in the community of Viborg, Denmark. Acta Obstet Gynecol Scand 69: 7–10PubMedCrossRefGoogle Scholar
  8. Brans YN, Escobedo MB, Hayashi RH, Huff RW, Kagan-Hallett KS, Ramamurthy RS (1984) Perinatal mortality in a large perinatal centre: five-year review of 31 000 births. Am J Obstet Gynecol 148:284–289PubMedGoogle Scholar
  9. Brookes JAS, Hall-Craggs MA, Sams VR, Lees WR (1996) Noninvasive perinatal necropsy by magnetic resonance imaging. Lancet 348:1139–1141PubMedCrossRefGoogle Scholar
  10. Browne FJ (1925) On the abnormalities of the umbilical cord which may cause antenatal deaths. J Obstet Gynaecol Br Emp 32:17–48CrossRefGoogle Scholar
  11. Carey JC (1987) Diagnostic evaluation of the stillborn infant. Clin Obstet Gynecol 30:342–351PubMedCrossRefGoogle Scholar
  12. Cartlidge PHT, Dawson AT, Stewart JH, Vujanic GM (1995) Value and quality of perinatal and infant postmortem examinations. Br Med J 310:155–158CrossRefGoogle Scholar
  13. Chasnoff IR, Burns WJ, Schnoll SH, Burns KA (1985) Cocaine use in pregnancy. N Engl J Med 313:666–669PubMedCrossRefGoogle Scholar
  14. Chiswick M (1985) Intrauterine growth retardation. Br Med J 291:845–848CrossRefGoogle Scholar
  15. Claireaux AE (1950) Haemolytic disease of the newborn. 1. A clinicopathological study of 157 cases. Arch Dis Child 25:61–70PubMedCrossRefGoogle Scholar
  16. Confidential Enquiry into Stillbirths and Deaths in Infancy (CESDI). 4th Annual Report (1997) Maternal and Child Health Research Consortium, LondonGoogle Scholar
  17. Creagh MD, Malia RG, Cooper SM, Smith AR, Duncan SLB, Greaves M (1991) Screening for lupus anticoagulant and anticardiolipin antibodies in women with fetal loss. J Clin Pathol 44:45–47PubMedCrossRefGoogle Scholar
  18. Delprado WJ, Baird PJ (1984) The fetal adrenal gland: lipid distribution with associated intrauterine hypoxia. Pathology 16:25–29PubMedCrossRefGoogle Scholar
  19. Drut RM, Harris CP, Drut R, Meisner L (1992) Use of fluorescent in situ hybridisation to detect trisomy 13 in archival tissues for cytogenetic diagnosis. Pediatr Pathol 12:799–805PubMedCrossRefGoogle Scholar
  20. Edmonds HW (1954) The spiral twist of the normal umbilical cord in twins and in singletons. Am J Obstet Gynecol 67:102–120PubMedGoogle Scholar
  21. Elechi EN, Elechi GN (1995) Mummified and calcified abdominal pregnancy (lithopaedion). Tr Doctor 25:125–126Google Scholar
  22. Fay RA (1983) Fetomaternal haemorrhage as a cause of fetal morbidity and mortality. Br J Obstet Gynaecol 90:443–446PubMedCrossRefGoogle Scholar
  23. Fox H (1978) Pathology of the placenta. Saunders, LondonGoogle Scholar
  24. Furness ME, Weckert RC, Parker SA, Knowles S (1989) Ultrasound in perinatal necropsy. J Med Genet 26:368–372PubMedCrossRefGoogle Scholar
  25. Garcia AGP, Basso NGDS, Fonseca MEF, Outani HN (1990) Congenital Echovirus infection-morphological and viro-logical study of fetal and placental tissue. J Pathol 160:123–127PubMedCrossRefGoogle Scholar
  26. Genest DR (1992) Estimating the time of death in stillborn fetuses: II. Histologic evaluation of the placenta; a study of 71 stillborns. Obstet Gynecol 80:585–592PubMedGoogle Scholar
  27. Genest DR, Singer DB (1992) Estimating the time of death in stillborn fetuses: III. External fetal examination; a study of 86 stillborns. Obstet Gynecol 80:593–600PubMedGoogle Scholar
  28. Genest DR, Granter S, Pinkus GS (1997) Umbilical cord “pseudovasculitis” following second trimester fetal death: a clinicopathological and immunohistochemical study of 13 cases. Histopathol 30:563–569CrossRefGoogle Scholar
  29. Georgsdottir I, Geirsson RT, Johannsson JH, Biering G, Snaedal G (1989) Classification of perinatal and late neonatal deaths in Iceland. Acta Obstet Gynecol Scand 68:101–108PubMedCrossRefGoogle Scholar
  30. Gilbert ER, Zugibe FT (1974) Torsion and constriction of the umbilical cord. A cause of fetal death. Arch Pathol 97:58–59PubMedGoogle Scholar
  31. Gilbert-Barness E (1997) Potter’s pathology of the fetus and infant. Mosby, St. Louis, MissouriGoogle Scholar
  32. Harcke HT, Naeye RL, Storch A, Blanc WA (1972) Perinatal cerebral intrauterine haemorrhage. J Pediatr 80:37–42PubMedCrossRefGoogle Scholar
  33. Hawthorne G, Robson S, Ryall EA, Sen D, Roberts SH, Ward Platt MP (1997) Prospective population based survey of outcome of pregnancy in diabetic women: results of the Northern Diabetic Pregnancy Audit, 1994. BMJ 315:279–281PubMedCrossRefGoogle Scholar
  34. Heifetz S (1983) Single umbilical artery: a statistical analysis of 237 autopsy cases. Lab Invest 48:6Google Scholar
  35. Hill LM, Macpherson T, Belfar HL, Kislak S (1989) Role of the perinatal autopsy in evaluating unusual sonographic findings of intrauterine fetal death. Am J Perinatol 6:331–333PubMedCrossRefGoogle Scholar
  36. Hovatta O, Lipasti A, Rapola J, Karjalainen O (1983) Causes of stillbirth: a clinicopathological study of 243 patients. Br J Obstet Gynaecol 90:691–696PubMedCrossRefGoogle Scholar
  37. Ibbetson S J, Cochrane L, Castle B, Becroft DMO (1994) Intrachorial placental haematoma at cord insertion and stillbirth: a case report. Aust NZ J Obstet Gynaecol 34:607–609CrossRefGoogle Scholar
  38. Kalifa G, Barbet JP, Labbe F, Houette A, Sellier N (1989) Value of systemic post-mortem radiographic examinations of fetuses - 400 cases. Pediatr Radiol 19:111–113PubMedCrossRefGoogle Scholar
  39. Kalousek DK, Pantzar T, Craver R (1988) So-called primitive neuroectodermal tumor in aborted previable fetuses. Pediatr Pathol 8:503–511PubMedCrossRefGoogle Scholar
  40. Keeling JW (1987). Macerated stillbirth. In: Keeling JW (ed) Fetal and neonatal pathology. Springer-Verlag, London, pp 167–177Google Scholar
  41. Kleinman JC, Pierre MB Jr, Madans JH, Land GH, Schramm WF (1988) The effects of maternal smoking on fetal and infant mortality. Am J Epidemiol 127:274–282PubMedGoogle Scholar
  42. Kochenour NK (1987) Other causes of fetal death. Clin Obstet Gynecol 30:312–321PubMedCrossRefGoogle Scholar
  43. Lau TK, Li CY (1994). A perinatal audit of stillbirths in a teaching hospital in Hong Kong. Aust NZJ Obstet Gynaecol 34:416–421CrossRefGoogle Scholar
  44. Laube DW, Schauberger CW (1982) Fetomaternal bleeding as a cause for “unexplained” fetal death. Obstet Gynecol 60:649–651PubMedGoogle Scholar
  45. Lessing JB, Amster R, Berger SA, Peyser MR (1989) Bacterial infection and human fetal wastage. J Reprod Med 34:975–976PubMedGoogle Scholar
  46. Lin CH, Lindheimer MD, River P, Moawad AH (1982) Fetal outcome in hypertensive disorders of pregnancy. Am J Obstet Gynecol 142:255–260PubMedGoogle Scholar
  47. Machin GA (1975) A perinatal mortality survey in south-east London 1970–73: the pathological findings in 726 necropsies. J Clin Pathol 28:428–434PubMedCrossRefGoogle Scholar
  48. Madan E, Meyer MP, Amortegui AJ (1988) Isolation of genital mycoplasmas and Chlamydia trachomatis in stillborn and neonatal autopsy material. Arch Pathol Lab Med 112:749–751PubMedGoogle Scholar
  49. Magani IM, Rafla NH, Mortimer G, Meehan FP (1990) Stillbirths: a clinicopathological survey (1972–1982) Pediatr Pathol 10:363–374PubMedCrossRefGoogle Scholar
  50. Meagher S, Boyd B (1993) Intrapartum stillbirth and suboptimal care. J Foet Med 13:8–11Google Scholar
  51. Mimouni F, Miodovnik M, Siddiqi T, Khoury J, Tsang RC (1988) Perinatal asphyxia in infants of insulin-dependent diabetic mothers. J Pediatr 113:345–353PubMedCrossRefGoogle Scholar
  52. Moore CM, McAdams AJ, Sutherland J (1969) Intrauterine disseminated intravascular coagulation: a syndrome of multiple pregnancy with a dead twin fetus. J Pediatr 74:523–528PubMedCrossRefGoogle Scholar
  53. Morrison I, Olsen J (1985) Weight-specific stillbirths and associated causes of death: an analysis of 765 stillbirths. Am J Obstet Gynecol 152:975–980PubMedGoogle Scholar
  54. Mueller RF, Sybert VP, Johnson J, Brown ZA, Chen WJ (1983) Evaluation of a protocol for post-mortem examination of stillbirths. N Engl J Med 309:586–590PubMedCrossRefGoogle Scholar
  55. Naeye RL (1977) Causes of perinatal mortality in the US collaborative perinatal project. JAMA 238:228–229PubMedCrossRefGoogle Scholar
  56. Naeye RL (1978) Placenta previa. Predisposing factors and effects on the fetus and surviving infants. Obstet Gynecol 52:521–525PubMedGoogle Scholar
  57. Naeye RL (1980) Abruptio placentae and placenta praevia. Frequency, perinatal mortality and cigarette smoking. Obstet Gynecol 55:701–704PubMedGoogle Scholar
  58. Naeye RL (1983) Maternal age, obstetric complications and the outcome of pregnancy. Obstet Gynecol 61:210–216PubMedGoogle Scholar
  59. Nilsson IM, Astedt B, Hedner U, Berezin D (1975) Intrauterine death and circulating anticoagulant (“canti-thrombo-plastin”). Acta Med Scand 197:153–159PubMedCrossRefGoogle Scholar
  60. Nylund L, Lunell N-O, Lewander R, Persson B, Sarby B (1982) Uteroplacental blood flow in diabetic pregnancy: measurements with indium 113m and a computer-linked gamma camera. Am J Obstet Gynecol 144:298–302PubMedGoogle Scholar
  61. Owen J, Stedman CHM,. Tucker TL (1989) Comparison of predelivery versus postdelivery Kleihauer-Betke stains in cases of fetal death. Am J Obstet Gynecol 161:663–666PubMedGoogle Scholar
  62. Pauli RM, Reiser CA (1994) Winconsin Stillbirth Service Program: II. Analysis of diagnoses and diagnostic categories in the first 1000 referrals. Am J Med Genet 50:135–153PubMedCrossRefGoogle Scholar
  63. Pauli RM, Reiser CA, Lebovitz RM, Kirkpatrick SJ (1994) Wisconsin Stillbirth Service Program: I. Establishment and assessment of a community-based program for etiologic investigation of intrauterine deaths. Am J Med Genet 50:116–134PubMedCrossRefGoogle Scholar
  64. Pitkin RM (1987) Fetal death: diagnosis and management. Am J Obstet Gynecol 157:583–589PubMedGoogle Scholar
  65. Porter H J, Keeling JW (1987) Value of perinatal necropsy examination. J Clin Pathol 40:180–184PubMedCrossRefGoogle Scholar
  66. Rushton DI (1991) West Midlands perinatal mortality survey, 1987. An audit of 300 perinatal autopsies. Br J Obstet Gynaecol 98:624–627PubMedCrossRefGoogle Scholar
  67. Sander CH, Stevens NG (1984) Hemorrhagic endovasculitis of the placenta: an in depth morphologic appraisal with initial epidemiological observations. Pathol Annu 19:37–79PubMedGoogle Scholar
  68. Savitz DA, Whelan EA, Kleckner RC (1989) Effects of parents occupational exposures on risk of stillbirth, pre-term delivery and small-for-gestational age infants. Am J Epidemiol 129:1201–1218PubMedGoogle Scholar
  69. Sibai BM, Spinnato JA, Watson DL, Hill GA, Anderson GD (1984) Pregnancy outcome in 303 cases with severe pre-eclampsia. Obstet Gynecol 64:319–325PubMedGoogle Scholar
  70. Sims ME, Beckwitt Türkei S, Halterman G, Paul RH (1985) Brain injury and intrauterine death. Am J Obstet Gynecol 151:721–723PubMedGoogle Scholar
  71. Singer DB, Macpherson T (1991) Fetal death and the macerated stillborn fetus. In: Wigglesworth JS, Singer DB (eds). Textbook of fetal and perinatal pathology. Blackwell Scientific Publications, Oxford, pp 263–283Google Scholar
  72. Skullerud K, Skjaeraasen J (1988) Clinicopathological study of germinal matrix hemorrhage, pontosubicular necrosis, and periventricular leukomalacia in stillborn. Childs Nerv Syst 4:88–91PubMedGoogle Scholar
  73. Squier W, Keeling JW (1991) The incidence of prenatal brain injury. Neuropathol Appl Neurobiol 17:29–38PubMedCrossRefGoogle Scholar
  74. Steier JA, Akslen LA, Flesland O, Askvik K (1987) Fetal heart block, anti-SSA and anti-SSB antibodies. Association with intrauterine growth retardation, fetal death and lupus anticoagulant. Acta Obstet Gynecol Scand 66:737–739PubMedCrossRefGoogle Scholar
  75. Strachan GI (1922) The pathology of foetal maceration. A study of 24 cases. Br Med J ii:80–82CrossRefGoogle Scholar
  76. Sun Y, Arbuckle S, Hocking G (1995) Umbilical cord stricture and intrauterine fetal death. Ped Pathol Lab Med 15: 723–732CrossRefGoogle Scholar
  77. Sutherland GR, Carter RF (1983) Cytogenetic studies: an essential part of the paediatric necropsy. J Clin Pathol 36:140–142PubMedCrossRefGoogle Scholar
  78. Taylor SR, Roessmann U (1984) Hypotensive brain stem necrosis in a stillborn. Acta Neuropathol (Berl) 65:166–167bCrossRefGoogle Scholar
  79. Weber J (1963) Constriction of the umbilical cord as a cause of foetal death. Acta Obstet Gynecol Scand 42:259–268PubMedCrossRefGoogle Scholar
  80. Whitfield CR, Smith NC, Cockburn F, Gibson AAM (1986) Perinatally related wastage — a proposed classification of primary obstetric factors. Br J Obstet Gynaecol 93:694–703PubMedGoogle Scholar
  81. Wigglesworth J (1984) Perinatal pathology. Saunders, LondonGoogle Scholar
  82. Wright C, Hinchliffe SA, Taylor C (1996) Fetal pathology in intrauterine death due to parvovirus B19 infection. Br J Obstet Gynaecol 103:133–136PubMedCrossRefGoogle Scholar

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© Springer-Verlag London 2001

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  • Isabella E. Moore

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