Degree Of Maceration Research Articles

Diagnostic quality of 3Tesla postmortem magnetic resonance imaging in fetuses with and without congenital heart disease

Postmortem confirmation of prenatally diagnosed congenital heart disease after termination of pregnancy and evaluation of potential cardiac defects after spontaneous fetal or neonatal death are essential. Conventional autopsy rates are decreasing, and 1.5Tesla magnetic resonance imaging has demonstrated limited diagnostic accuracy for postmortem cardiovascular assessment. This study aimed to evaluate the feasibility and image quality of cardiac 3Tesla postmortem magnetic resonance imaging and to assess its diagnostic accuracy in detecting fetal heart defects compared with conventional autopsy. Secondarily, the study aimed to explore whether clinical factors affect the quality of 3Tesla postmortem magnetic resonance imaging. A total of 222 consecutive fetuses between 12 and 41 weeks' gestation, who underwent 3Tesla postmortem magnetic resonance imaging and conventional autopsy after spontaneous death or termination of pregnancy for fetal malformations, were included. First, 3Tesla postmortem magnetic resonance imaging of each fetus was rated as diagnostic or nondiagnostic for fetal cardiac assessment by 2 independent raters. The image quality of individual cardiac structures was then further evaluated by visual grading analysis. Finally, the presence or absence of a congenital heart defect was assessed by 2 radiologists and compared with autopsy results. Overall, 87.8% of 3Tesla postmortem magnetic resonance imaging examinations were rated as diagnostic for the fetal heart. Diagnostic imaging rates of individual cardiac structures at 3Tesla postmortem magnetic resonance imaging ranged from 85.1% (atrioventricular valves) to 94.6% (pericardium), with an interrater agreement of 0.82 (0.78-0.86). Diagnostic imaging of the fetal aortic arch and the systemic veins at 3Tesla postmortem magnetic resonance imaging was possible from 12+5 weeks' gestation onward in 90.1% and 92.3% of cases, respectively. A total of 55 fetuses (24.8%) had at least 1 cardiac anomaly according to autopsy, 164 (73.9%) had a normal heart, and in 3 fetuses (1.4%), autopsy was nondiagnostic for the heart. Considering all examinations rated as diagnostic, 3Tesla postmortem magnetic resonance imaging provided high diagnostic accuracy for the detection of fetal congenital heart defects with a sensitivity of 87.8%, a specificity of 97.9%, and concordance with autopsy of 95.3%. 3Tesla postmortem magnetic resonance imaging was less accurate in young fetuses (<20 weeks compared with ≥20 weeks; P<.001), in fetuses with low birthweight (≤100 g compared with >100 g; P<.001), in cases after spontaneous fetal death (compared with other modes of death; P=.012), in cases with increasing latency between death and 3Tesla postmortem magnetic resonance imaging (P<.001), and in cases in which there was a high degree of maceration (maceration score of 3 compared with a score from 0 to 2; P=.004). Diagnostic 3Tesla postmortem magnetic resonance imaging assessment of the fetal heart is feasible in most fetuses from 12 weeks' gestation onward. In diagnostic images, sensitivity and, particularly, specificity in the detection of congenital heart disease are high compared with conventional autopsy. Owing to its high diagnostic accuracy, we suggest that 3Tesla postmortem magnetic resonance imaging may serve as a suitable imaging modality with which to direct a targeted conventional autopsy when pathology resources are limited or to provide a virtual autopsy when full autopsy is declined by the parents.

Postmortem MRI Evaluation of Maceration Degree of Deceased Fetus.

We studied the possibilities of postmortem MRI for assessing the degree of maceration and determining the duration of intrauterine fetal death. Postmortem radiological and pathoanatomic study of the bodies of 38 stillbirths who died antenatally (main group, n=31) and intranatally (control group, n=5), who were born at gestational periods of 22-40 weeks was performed. Before the autopsy, MRI was performed in standard T1 and T2 modes. The tissue of the liver, kidney, brain, femoral muscle, lung, and skin in the hip, abdomen, and skull were studied on T1- and T2-weighted images (WI), followed by calculation of the of MR signal intensity ratio in T2- and T1-WI (SIR). The duration of intrauterine fetal death was determined based on the results of autopsy and analysis of histological preparations. It was found that the calculated values of SIR depended on the evaluated organ and the duration of intrauterine fetal death. Unfortunately, the revealed dynamics of changes in SIR does not allow unambiguous assessment of the severity of maceration processes and, accordingly, the time of fetal death due to its non-linear nature. Nevertheless, the use of SIR indicators of several organs and areas of the body makes it easier to determine the duration of intrauterine fetal death and, hence, to clarify the links of thanatogenesis of the stillborn. The advantages of post-mortem MRI compared to autopsy include non-invasive nature of the study, the possibility of archiving and subsequent multiple delayed analysis of tomograms, as well as the speed of MRI analysis, in contrast to microscopic stage of pathological examination associated with the need to prepare histological preparations.

Unrecognized viral infections and chromosome abnormalities as a cause of fetal death - examination with fluorescence insitu hybridization, immunohistochemistry and polymerase chain reaction.

Fifteen to 50% of fetal deaths remain unexplained after post-mortem examination depending on inclusion criteria and classification systems. Our aim was to examine a selection of unexplained fetal deaths in order to investigate whether any common chromosome aberrations or viral infections were present. Reports from 351 fetal autopsies performed at the Department of Pathology and Medical Genetics at St. Olavs University Hospital from 2001 through 2010 were reviewed. Of these, 105 fetal deaths were classified as unexplained. Tissue samples from 30 cases were further examined with fluorescence insitu hybridization (FISH) to detect abnormalities in chromosomes 13, 18, and 21. The samples were also examined with immunohistochemistry (IHC) and polymerase chain reaction (PCR) to detect infections with cytomegalovirus, parvovirus B19, herpes simplex virus 1 and 2, enterovirus, and parechovirus. In two cases, a possible trisomy 13 mosaicism was found. No viruses were detected. In our selection of 30 unexplained cases, possible trisomy 13 mosaicism was found in two cases, and no viruses were detected. High degree of maceration and missing placental examination often complicate the investigation of fetal death, and extensive ancillary examinations do not necessarily contribute to a more specific diagnosis.

Treatment of carrots with spent green tea extract reduces the soft rot of Pectobacterium spp.

In the present study the antibacterial activity of spent green tea (SGT) was evaluated against Pectobacterium spp. causing soft rot incidence. Gas chromatography and mass spectroscopy (GC-MS) analysis reveal the presence of caffeine in the SGT extracts. Time kill assay revealed that SGT was able to kill Pectobacterium spp. at 18 h at 10 × MIC and at 24 h at 1 × MIC concentration. SGT led to the significant decrease in pectin lyase (PL), polygalcturonase (PG) and pectin methyl esterase activity in carrots challenge inoculated with Pectobacterium spp. SGT treated carrots recorded low degree of maceration, and relative electrolyte leakage (REL) values and also maintained high β carotene content, phenolic content and total antioxidant percentage. Based on the results of this study it could be concluded that SGT was able to offer protection to carrot against soft rot causing Pectobacterium spp. under post-harvest storage conditions.

Effects of intrauterine retention and postmortem interval on body weight following intrauterine death: implications for assessment of fetal growth restriction at autopsy.

According to the classification system used, 15-60% of stillbirths remain unexplained, despite undergoing recommended autopsy examination, with variable attribution of fetal growth restriction (FGR) as a cause of death. Distinguishing small-for-gestational age (SGA) from pathological FGR is a challenge at postmortem examination. This study uses data from a large, well-characterized series of intrauterine death autopsies to investigate the effects of secondary changes such as fetal maceration, intrauterine retention and postmortem interval on body weight. Autopsy findings from intrauterine death investigations (2005-2013 inclusive, from Great Ormond Street Hospital and St George's Hospital, London) were collated into a research database. Growth charts published by the World Health Organization were used to determine normal expected weight centiles for fetuses born ≥ 24 weeks' gestation, and the effects of intrauterine retention (maceration) and postmortem interval were calculated. There were 1064 intrauterine deaths, including 533 stillbirths ≥ 24 weeks' gestation with a recorded birth weight. Of these, 192 (36%) had an unadjusted birth weight below the 10th centile and were defined as SGA. The majority (86%) of stillborn SGA fetuses demonstrated some degree of maceration, indicating a significant period of intrauterine retention after death. A significantly greater proportion of macerated fetuses were present in the SGA population compared with the non-SGA population (P = 0.01). There was a significant relationship between increasing intrauterine retention interval and both more severe maceration and reduction in birth weight (P < 0.0001 for both), with an average artifactual reduction in birth weight of around -0.8 SD of expected weight. There was an average 12% reduction in fetal weight between delivery and autopsy and, as postmortem interval increased, fetal weight loss increased (P = 0.0001). Based on birth weight alone, 36% of stillbirths are classified as SGA. However, fetuses lose weight in utero with increasing intrauterine retention and continue to lose weight between delivery and autopsy, resulting in erroneous overestimation of FGR. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.

Quantification of maceration changes using post mortem MRI in fetuses.

BackgroundPost mortem imaging is playing an increasingly important role in perinatal autopsy, and correct interpretation of imaging changes is paramount. This is particularly important following intra-uterine fetal death, where there may be fetal maceration. The aim of this study was to investigate whether any changes seen on a whole body fetal post mortem magnetic resonance imaging (PMMR) correspond to maceration at conventional autopsy.MethodsWe performed pre-autopsy PMMR in 75 fetuses using a 1.5 Tesla Siemens Avanto MR scanner (Erlangen, Germany). PMMR images were reported blinded to the clinical history and autopsy data using a numerical severity scale (0 = no maceration changes to 2 = severe maceration changes) for 6 different visceral organs (total 12). The degree of maceration at autopsy was categorized according to severity on a numerical scale (1 = no maceration to 4 = severe maceration). We also generated quantitative maps to measure the liver and lung T2.ResultsThe mean PMMR maceration score correlated well with the autopsy maceration score (R2 = 0.93). A PMMR score of ≥4.5 had a sensitivity of 91 %, specificity of 64 %, for detecting moderate or severe maceration at autopsy. Liver and lung T2 were increased in fetuses with maceration scores of 3–4 in comparison to those with 1–2 (liver p = 0.03, lung p = 0.02).ConclusionsThere was a good correlation between PMMR maceration score and the extent of maceration seen at conventional autopsy. This score may be useful in interpretation of fetal PMMR.

Diffusion-weighted post-mortem magnetic resonance imaging of the human fetal brain in situ

PurposeTo evaluate perinatal brain apparent diffusion coefficient (ADC) values at postmortem MRI (PMMR) in order to evaluate post mortem changes. Materials and methodsPostmortem brain MRI was performed with diffusion gradient values b=0, 500, and 1000s/mm2 on 43 fetal cases. Mean ADC values were calculated from 7 regions of interest (ROIs) throughout the brain. Results43 fetuses were evaluated with median gestational age 36 weeks (range 21–41). Overall, fetal brain ADC varied with maceration score, but not with gestational age or post mortem interval. The best single predictor of brain ADC was maceration score, which accounted for 52% of data variation for frontal cortex (p<0.001) and 44% in basal ganglia (p<0.001), and between 24% and 32% in all five of the other included brain areas. Gestation was only significantly associated with occipital ADC changes and post mortem interval only significantly associated with basal ganglia ADC changes. Median intra-observer and inter-observer variability was 6.0% (95% range 1.0%–18.1%) and 8.0% (95% range 0.2%–33.9%) respectively. ConclusionDWI characteristics in different fetal brain areas following death are multifactorial, with maceration the strongest predictor in most anatomical areas. Deep grey matter areas are also affected by gestation and post mortem interval. With better models, brain ADC may be useful to estimate the degree of maceration where gestation and post mortem interval is unknown.

Microbiota on Spoiled Vegetables and Their Characterization

Spoilage causes vegetables to deteriorate and develop unpleasant characteristics. Approximately 30 % of fresh vegetables are lost to spoilage, mainly due to colonization by bacteria. In the present study, a total of 44 bacterial isolates were obtained from a number of spoiled vegetables. The isolates were identified and classified into 20 different species of 14 genera based on fatty acid composition, biochemical tests, and 16S rDNA sequence analyses. Pseudomonas spp. were the species most frequently isolated from the spoiled vegetables. To evaluate the spoilage ability of each species, a variety of fresh vegetables were treated with each isolate and their degree of maceration was observed. In addition, the production of plant cell wall-degrading enzymes (PCWDEs), such as cellulase, xylanase, pectate lyase, and polygalacturonase, was compared among isolates to investigate their potential associations with spoilage. Strains that produce more PCWDEs cause spoilage on more diverse plants, and pectinase may be the most important enzyme among PCWDEs for vegetable spoilage. Most gram-negative spoilage bacteria produced acylated homoserine lactone, a quorum-sensing signal molecule, suggesting that it may be possible to use this compound effectively to prevent or slow down the spoilage of vegetables contaminated with diverse bacteria.

A Comparison of Stillborn Birth Weights and Postmortem Weights

Birth weights obtained by the nurses in the labor and delivery room were compared with the postmortem weights examination prospectively in 212 stillborns. The effects of gestational age, degree of maceration, birth weight, gender, and time elapsed from delivery to postmortem examinations were also examined. There were 96 female and 116 male stillborns in the study. The gestational ages ranged from 14 to 42 weeks. The degree of maceration ranged from 0 to 5, 0 being no maceration and 5 representing the most extreme condition, which was mummification. There was an average of a 50 g decrease in the weights of all stillborns when their birth weights and postmortem weights were compared. This was equal to an average relative weight loss of 7.1%. When all the variables were examined, only the degree of maceration and gestational age were identified to play significant roles in weight loss (P < 0.0001 for both). A higher degree of maceration meant more weight loss, whereas older gestational age led to less weight loss. There is significant discrepancy between the birth and postmortem examination weights of stillborns. Although gender, birth weight, and time elapsed from delivery to postmortem examination did not have any significant effects, the degree of maceration and gestational age affected the observed weight loss. In stillborns, birth weights are more accurate than weights obtained at postmortem examination.

Effects of maceration of rice straw on voluntary intake and performance of growing beef cattle fed rice straw-based rations

Effects of field scale maceration on voluntary intake of rice straw, diet digestibility of neutral detergent fiber (aNDF) and performance of growing cattle were evaluated through chemical, in vitro and animal feeding experiments over a 3-year period. Due to the sequential nature of the study (i.e., a discrete experiment was completed in each year), the method of maceration differed among years. However, in each year, replicated rice fields of approximately 2.4 ha each, which had been managed similarly during growth, were harvested with or without maceration immediately after harvest. While no quantitative measure of maceration was applied in any experiment, the extent of maceration in year 1 was visually judged to be very light, characterized by only a few stem punctures and no longitudinal stem shredding. In year 2, the extent of stem puncture was increased, most internodes were crushed and a small amount of longitudinal shredding had occurred and, in year 3, the amount of internode crushing and longitudinal shredding was extreme. In each feeding experiment, cattle were managed in groups of 8–10 and fed the experimental diets for a 14-day adaptation period prior to weighing on day 0 of the study. Diets consisted of alfalfa hay, concentrate ingredients and rice straw that were fed for ad libitum intake. In general, the chemical composition of the rice straw was typical of California rice straw and, in spite of some differences due to maceration within year, there was no consistent impact on any analyte among years. In each year, the macerated rice straw had a numerically higher calculated metabolizable energy value, but these differences failed to reach statistical significance. The 30 h in vitro digestibility of aNDF in the feces of cattle fed macerated straw was lower (P<0.01) in each study, although the absolute level of aNDF in feces did not differ. Whole tract digestion of dietary aNDF was not impacted by rice straw maceration in experiment 1, was weakly numerically increased in experiment 2 (i.e., P=0.45), and approached statistical significance in experiment 3 (i.e., P=0.07), as the degree of maceration increased. Voluntary dry matter (DM) intake was numerically lower in cattle fed macerated rice straw in each experiment, and both the numerical extent and statistical support for that decline increased from experiments 1 to 3 as the degree of maceration of the rice straw increased, such that the 0.47 kg/d decline in DM intake by feeding macerated straw in experiment 3 was different (i.e., P<0.01). However, body weight gain was not impacted in any experiment and a shift from less efficient to more efficient gain/feed ratio from experiments 1 to 3 failed to reach statistical significance in any year. Maceration, in spite of substantial changes to the physical nature of the rice straw, failed to substantively impact animal performance.

The CT Risk Factors for the Need of Operative Treatment in Initially Hemodynamically Stable Patients After Blunt Hepatic Trauma

Most hemodynamically stable blunt hepatic trauma (BHT) patients are treated nonoperatively with a reported successful rate exceeding 80%. It is current clinical consensus that hemodynamic stability is the only determinant for a patient to be managed nonoperatively. However, conversion to operative treatment was found in around 10% of these patients. There were 214 computed tomography (CT) scans of hemodynamically stable patients with main or sole BHT studied. CT findings including injury severity grading, contrast extravasation, the amount of hemoperitoneum, the degree of maceration, the depth of laceration, the size of hematoma, and the involvement of great vessels were analyzed to determine risk factors leading to the need of operative treatment. Intraperitoneal contrast extravasation, hemoperitoneum in six compartments, maceration >2 segments, high Mirvis' CT grade as well as American Association for the Surgery of Trauma injury scale, laceration > or =6 cm in depth, and porta hepatis involvement occurred significantly more frequently (p < or = 0.001, respectively) in patients who needed operative treatment. Logistic regression analysis identified "intraperitoneal contrast extravasation" (RR = 12.5, 95% CI: 7.8-20.0; p < 0.001) and "hemoperitoneum in six compartments" (RR = 22, 95% CI: 9.7-49.4; p < 0.001) to independently contribute to the need of operative treatment. Intraperitoneal contrast extravasation and hemoperitoneum in six compartments on CT scan both indicate massive or active hemorrhage and should be regarded as high risk for the need of operation in hemodynamically stable patients after BHT. Patients with low risk profile can be successfully treated with nonoperative modalities.

Method for Measuring the Degree of Maceration of Fermented Soybean.

The force-deformation curve of bulk soybean fermented with Rhizopus could be described by the equation, F=C(Δe)n. The degree of maceration of fermented soybean (a measure of softness) was estimated by the n-value of the power of the equation and depended on the Rhizopus strain used. Of the Rhizopus strains tested, R. oligosporus TISTR3001 (well known as a dominant tempeh processing species) and Rhizopus sp. LKN (isolated from a tempeh starter) gave high degrees of maceration corresponding to n=1.3 (initial value of 1.8) and 1.6 (initial value of 1.8) respectively, for 60 h of fermentation of raw soybeans at 30°C. On the other hand, the R. oligosporus TISTR3001 and Rhizopus sp. LKN for sterilized soybeans decreased to n-values of 1.5 from initial value of 1.7 and to 1.3 from initial value of 1.7, respectively, for 60 h of fermentation at 30°C. n-Values less than 1.5 were considered to indicate a considerably high degrees of maceration.

Pectin lyase is a key enzyme in the maceration of potato tuber

The maceration of potato tuber (Solanum tuberosum cv Bintje) by technical enzyme preparations was examined with the aid of fluorescence microscopy using fluorescein diacetate as a dye. Treatment with Pectinex Ultra-SP-L from Aspergillus aculeatus resulted in a higher release of single viable cells and smaller clumps of cells than treatment with Rohament P from Aspergillus niger. Fractions with high pectin lyase and low polygalacturonase activity obtained by anion exchange chromatography of Pectinex Ultra SP-L showed the highest degree of maceration. When two different cloned polygalacturonases (PG1 and PG2) and a cloned pectin lyase (PL1) from A aculeatus were examined, the highest degree of maceration was observed with PL1. In conclusion, pectin lyase is probably the main enzyme in Pectinex Ultra-SP-L responsible for the maceration of potato tuber. © 1997 SCI.

Effect of Enzymes on the Degree of Maceration of Soybean Fermented by Rhizopus Strains

Effect of Enzymes on the Degree of Maceration of Soybean Fermented by Rhizopus Strains

Development of Method for Measuring the Degree of Maceration of Soybean Fermented with Rhizopus

Development of Method for Measuring the Degree of Maceration of Soybean Fermented with Rhizopus

Characterization of two Sclerotinia sclerotiorum polygalacturonases with different abilities to elicit glyceollin in soybean

Two endo-polygalacturonase isoenzymes (PG-II and PG-IV), with masses of 34 and 30 kDa respectively, were purified from soybean hypocotyls infected by Sclerotinia sclerotiorum. The pH optimum for both isoenzymes was about 4.6, but PG-IV exhibited a broader range of pH activity. PG-IV showed a much higher affinity for pectin than did PG-II. PG-II hydrolyzed polygalacturonic acid in a more random fashion than PG-IV. Oligouronides produced by PG-II showed a higher phytoalexin elicitor activity. PG-IV produced a large degree of maceration of soybean hypocotyls releasing a significant amount of uronides. The properties of PG-II and PG-IV are discussed in relation to the different ability of the two isoenzymes to elicit glyceollin in soybean.

Predicting in vitro tissue culture growth for cytogenetic evaluation of stillborn fetuses

A prospective study was undertaken of 131 perinatal deaths to determine whether gestational age, body weight, maceration degree and autopsy interval influenced successful in vitro tissue culture for cytogenetic evaluation. Perinatal populations were categorized as neonatal death (NND), fresh stillbirth (FSB), or graded as macerated stillbirth (MAC-0, MAC-1, MAC-2, MAC-3). Metaphase production by at least 15 cells separated ‘growth’ from ‘no growth’ categories after sampling liver, kidney and spleen. Body weight and degree of maceration were predictive of successful ‘growth’, while gestational age and autopsy interval were not. Body weight was significant in separating ‘growth’ from ‘no growth’ in NND ( P = 0.05), FSB, MAC-0 and MAC-1 ( P = 0.01). Growth probabilities were 0.78 (NND), 0.57 (FSB), 0.49 (MAC-0), 0.38 (MAC-1) and zero for MAC-2 and MAC-3. We conclude that (a) tissues from MAC-2 and MAC-3 fetuses do not grow and thus need not be sampled at autopsy, (b) maceration degree and body weight can be used to predict the growth probability in the other categories, (c) tissue samples can be taken during daylight hours, since autopsy interval does not influence successful growth provided the fetus is refrigerated at 4 °C, (d) all of the above conclusions have cost-efficiency implications for cytogenetic laboratories.

Factors Affecting Wet Strength of Macerated Forage Mats

ABSTRACT FAST-DRYING macerated forage mats must have adequate wet strength to allow placing them intact on the stubble. The effect on wet strength of variables including pressure and time of formation, degree of maceration, dry matter density, and fiber orientation is studied. Energy of formation is also given.

Leaf proteins for foods.

Leaf proteins for foods.

Intrafetal gas.

The earliest stage in pregnancy at which intrafetal gas can be demonstrated radiographically is the eighth month (2). Stewart (9, 10) in in vitro experiments found no relationship between the degree of maceration, the quantity of gas present, and the interval between fetal death and the radiographic examination. Gas has been seen in the retroperitoneal area prenatally and postnatally (8, 10), the peritoneal cavity prenatally and postnatally (5, 10), the thoracic wall antenatally and postnatally (10), the cranial cavity antenatally (6), the shoulder joint postnatally (1), and the vertebral canal prenatally (1). Case Material and Methods The radiographs of 53 cases of intrauterine fetal death, in which intravascular gas was demonstrated, were carefully reviewed with special reference to the possible coexistence of extravascular gas. All patients were examined by Edholm's method (3). We wished to investigate (a) the incidence of extravascular gas; (b) whether it is possible to distinguish intrafetal gas from maternal gas or from translucent tissue such as fetal fat, and (c) whether it is possible to determine radiographically in which vessels the gas is contained. In 2 of the 53 cases, gas was seen in the vertebral canal, and these were the only cases in which extravascular gas was identified. Case I: W. U., aged twenty-seven years, gravida III, Para 2. The patient was Rh-positive. The two previous pregnancies were uncomplicated; the present one had proceeded normally, the expected date of delivery being April 7. On April 13 fetal movements ceased, and on April 16 radiography disclosed intravascular gas and gas in the lumbosacral portion of the vertebral canal (Fig. 1). A second roentgen examination on April 17 demonstrated only the intravascular gas. Following medical induction of labor, the patient was delivered of a full-term, stillborn infant. Postmortem examination performed on April 18 showed gross maceration. Case II. K. E., aged twenty-three years, gravida II, Para 1. The previous pregnancy had been uneventful. During the present pregnancy Rh antibodies were demonstrated. The expected date of delivery was Aug. 18. Fetal movements ceased on July 7. Radiography on Aug. 7 disclosed gas in the lumbosacral portion of the vertebral canal coexisting with intravascular gas (Fig. 2). Following medical induction of labor, the patient was delivered of a full-term, stillborn infant. Postmortem examination performed twelve days after the radiographic study showed gross maceration. With Edholm's method the maternal intestines are displaced and not superimposed on the fetal shadows, thereby permitting a differential diagnosis between intrafetal and maternal gas to be made with confidence. To make certain that the streak of translucency in the fetal vertebral canal actually represented gas (Figs. 1 and 2), the lateral films taken prenatally by Edholm's method in 90 cases of intrauterine pregnancy, in which the fetus was alive, were also carefully reviewed.