Stillbirth and intrauterine fetal death: role of routine histopathological placental findings to determine cause of death Article Swipe
Jessica Man
,
J. Ciaran Hutchinson
,
Alexander Heazell
,
Michael T. Ashworth
,
Iona Jeffrey
,
Neil J. Sebire
·
YOU?
·
· 2016
· Open Access
·
· DOI: https://doi.org/10.1002/uog.16019
YOU?
·
· 2016
· Open Access
·
· DOI: https://doi.org/10.1002/uog.16019
Objectives Placental abnormalities are a common cause of death in stillbirth, ranking second only to unexplained deaths, though there is wide variation in the proportion attributed to placental disease. In clinical practice, interpretation of the significance of placental findings is difficult, since many placental features in stillbirths overlap with those in live births. Our aim was to examine objectively classified placental findings from a series of > 1000 autopsies following intrauterine death in order to evaluate the role of placental histological examination in determining the cause of death. Methods As part of a larger study evaluating several aspects of autopsy findings in intrauterine death, a dedicated database was used to collate antenatal and postmortem examination details for all cases examined between 2005 and 2013 at two tertiary specialist centers in London, UK. Histological findings for placentas were evaluated in relation to the final cause of death. Results Among 1064 intrauterine deaths, 946 (89%) cases had the placenta submitted for examination as part of the autopsy. Of these, 307 (32%) cases had the cause of death assigned to abnormalities of the placenta, cord or membranes. Around one third of stillbirths (≥ 24 weeks) had some isolated placental histological abnormality identified, many of uncertain significance, a significantly greater proportion than in cases of second‐trimester intrauterine fetal demise ( P < 0.0001). The cause of death was ascending infection in 176/946 (19%) cases, peaking at 22 weeks' gestation, with significantly more black mothers having ascending infection compared with other ethnicities ( P < 0.0001). Maternal vascular malperfusion was the largest category of placental abnormalities in stillbirth, with peak prevalence in the early third trimester. There were 18 (2%) cases with specific histological abnormalities, including chronic histiocytic intervillositis and massive perivillous fibrin deposition. Conclusions Placental pathologies represent the largest category of cause of intrauterine death. Placental histological examination is the single most useful component of the autopsy process in this clinical setting. A minority of cases are associated with specific placental pathologies, often with high recurrence rates, that can be diagnosed only on microscopic examination of the placenta. Many deaths remain unexplained, although placental histological lesions may be present which are of uncertain significance. A rigorous, systematic approach to placental pathology research and classification may yield better understanding of the significance of placental findings and reduce the rate of unexplained intrauterine deaths. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
Related Topics
Concepts
Placenta
Medicine
Autopsy
Cause of death
Obstetrics
Fetal death
Pregnancy
Maternal death
Fetus
Intrauterine death
Gestation
Disease
Pathology
Biology
Population
Genetics
Environmental health
Metadata
- Type
- article
- Language
- en
- Landing Page
- https://doi.org/10.1002/uog.16019
- OA Status
- green
- Cited By
- 124
- References
- 26
- Related Works
- 10
- OpenAlex ID
- https://openalex.org/W2542061399
All OpenAlex metadata
Raw OpenAlex JSON
- OpenAlex ID
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https://openalex.org/W2542061399Canonical identifier for this work in OpenAlex
- DOI
-
https://doi.org/10.1002/uog.16019Digital Object Identifier
- Title
-
Stillbirth and intrauterine fetal death: role of routine histopathological placental findings to determine cause of deathWork title
- Type
-
articleOpenAlex work type
- Language
-
enPrimary language
- Publication year
-
2016Year of publication
- Publication date
-
2016-10-25Full publication date if available
- Authors
-
Jessica Man, J. Ciaran Hutchinson, Alexander Heazell, Michael T. Ashworth, Iona Jeffrey, Neil J. SebireList of authors in order
- Landing page
-
https://doi.org/10.1002/uog.16019Publisher landing page
- Open access
-
YesWhether a free full text is available
- OA status
-
greenOpen access status per OpenAlex
- OA URL
-
https://www.research.manchester.ac.uk/portal/en/publications/stillbirth-and-intrauterine-fetal-death(68c49db3-2092-43ed-b8a9-8b7d28884a08).htmlDirect OA link when available
- Concepts
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Placenta, Medicine, Autopsy, Cause of death, Obstetrics, Fetal death, Pregnancy, Maternal death, Fetus, Intrauterine death, Gestation, Disease, Pathology, Biology, Population, Genetics, Environmental healthTop concepts (fields/topics) attached by OpenAlex
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124Total citation count in OpenAlex
- Citations by year (recent)
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2025: 8, 2024: 21, 2023: 20, 2022: 20, 2021: 13Per-year citation counts (last 5 years)
- References (count)
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26Number of works referenced by this work
- Related works (count)
-
10Other works algorithmically related by OpenAlex
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| corresponding_author_ids | https://openalex.org/A5037501835 |
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| institutions_distinct_count | 6 |
| corresponding_institution_ids | https://openalex.org/I2800129641, https://openalex.org/I45129253 |
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