Fat distribution in the adrenal cortex as an indication of the mode of intrauterine death

Abstract

The presence of fat in the fetal zone of the adrenal cortex in the stillborn macerated fetus is indicative of the mode of intrauterine death. Three basic patterns are recognized. In the type I pattern there is only a scant amount of fat, close to the medullary zone. In the type II pattern fat is more widespread and is present in many more cells of the fetal zone. The type III pattern reflects a massive fatty change of almost all cells throughout the fetal cortical zone. Correlation of the three fat patterns with the pathology of the placenta and clinical data relevant to the etiology of intrauterine death has led to the following conclusions. The type I fat pattern is indicative of an acute mode of death, the type II pattern is indicative of a more prolonged period of intrauterine deterioration prior to death, whereas the type III pattern is indicative of a chronic mode of death. Determination of the fat patterns in the fetal zone of the adrenal cortex can be helpful when the clinician is confronted with the problem of fetal death, especially when maceration may hamper more detailed pathologic studies.