Fetal Death In Utero Research Articles

When Does the Fetus Become a Person? A French Retrospective Study and Review of the Literature of Rituals Related to Medical Interruptions of Pregnancies, in-utero Fetal Death, and Late Miscarriages

Background: To best accompany bereaved couples facing a dead fetus, as a midwife or a physician, and understand more precisely what they live, it seems important to ask us on what represents for the mother, parents, this little being whom they had to separate. This brings us to the question: what represents this fetus lost for parents? How is he regarded by contemporary society? Do parents feel respect or revulsion to the body of the deceased children? What is the place of these “babies” in our society. Objective: The objective of our study was to determine, in relation to the term, the beginning of “humanity” for the parents of a dead fetus. We wanted to determine a term (in the medical sense), if it exists, which can be considered the body as “sacred” (not just an inert entity) from the point of view of the parents. Material and Methods: The study was retrospective and single site: it was carried out at the hospital Necker (Paris 5). Anonymous data collection was carried out from September 2011 to March 2012. Inclusion criteria were: medical interruption of pregnancy, in-utero fetal death, and late miscarriage. In order to define some “humanity” of the fetus from the point of view of the parents, from the 9 binary variables collected, four independent qualitative scores were constructed: “Announcement”, “Vision”, “Investment” and “Offering”. Results: The study population included 310 cases, corresponding to fetus expulsed between September 2010 and November 2011. On all of those fetal deaths, we distinguished three different modes: 233 medical interruptions of pregnancy (75.16%), 57 in-utero fetal deaths (18.39%), 20 late miscarriages (6.45%). After a statistical analysis, the average term of “humanity” was determined as around 180 days (95%CI [167;192]). Discussion: Facing this term, we try to answer some questions: is the fetus a patient like any other? What is the place of the fetus in the society? Is there a special work of mourning for fetal deaths? Does-it change anything to see and feel the child? What is the place and importance of the fetus for the main religions? Practically, does-it change anything to the legal status of the fetus in France and elsewhere?

Fetal organ weight estimation by postmortem high‐field magnetic resonance imaging before 20 weeks' gestation

To ascertain whether high-field magnetic resonance imaging (MRI) allows accurate estimation of the weight of various fetal organs at postmortem before 20 weeks' gestation. From 23 fetuses at 9-20 weeks, following termination of pregnancy or in-utero fetal death (IUFD), 207 assorted fetal organs were evaluated by high-field MRI at 9.4 T prior to conventional autopsy. Fetal organ density was calculated by correlating volume and weight at autopsy using linear regression analysis, and this was used to estimate fetal organ weight by MRI. The relative error in MRI estimation of organ weight was calculated as follows: (|MRI weight - autopsy weight|/autopsy weight) × 100 (%). Multiple regression analysis was used to investigate the effect on the relative error of MRI organ weight estimates of gestational age at TOP or delivery following IUFD, autopsy weight, fetal organ examined, IUFD and fetal maceration. Of the 207 organs evaluated, 133 (64%) were examined for fetal organ density and 155 (75%) for fetal organ weight. Fifty-two organs were excluded from our analysis; 41 of these were from fetuses with IUFD, with 39 organs macerated. In 32 cases, exclusion was due to an inability to assess the organ both on MRI and on conventional autopsy. Volume and weight at autopsy correlated significantly, following the linear equation: autopsy volume = (0.9947 × autopsy weight) - 4.7556, where autopsy volume is in mm(3) and weight is in mg (r = 0.99, P < 0.001). Overall the mean relative error in the MRI estimation of organ weight was 68%. Multiple regression analysis showed that the relative error in the MRI estimation of organ weight was significantly associated with gestational age at TOP or delivery following IUFD and fetal maceration, but not with autopsy weight, fetal organ examined or IUFD. In the subgroup of non-macerated organs and for fetuses above 14 weeks' gestation, the mean relative error in the MRI estimation of organ weight was 34%. In fetuses before 20 weeks' gestation, noninvasive estimation of organ weight is feasible using high-field MRI, but there is a mean overestimation. Limitations of the technique occur mainly in cases of small macerated fetuses before 14 weeks' gestation.

Gestational alloimmune liver disease: a cause of fetal death in utero

Recent evidence suggests that neonatal haemochromatosis is caused by gestational alloimmune liver disease (GALD), and is an underdiagnosed entity, especially in cases of unexplained stillbirth or premature birth. 1 We present an autopsy case of a 35-year-old mother, G4P3, who was diagnosed with fetal death in utero (FDIU) at 32 weeks gestation. She had a previous child born with severe liver damage of unknown cause but suspected to be alloimmune. Her subsequent pregnancy was treated with immu-noglobulin and she delivered a normal child. This pregnancy immunoglobulin was not administered due to side-effects. At 32 weeks she noticed reduced fetal movements and FDIU was diagnosed. A full autopsy was performed which found features of terminal hypoxia, advanced liver autolysis, but no morphological abnormalities and negative Perls stain. Due to high clinical suspicion of neonatal haemochromatosis, liver autopsy samples and liver biopsy of child with severe hepatitis were sent to Children’s Memorial Research Centre, Chicago, for further analysis. Slides were stained with C5b-9 complex and were unequivocally positive in both liver biopsies. This is strong evidence that FDIU and severe hepatitis was due to GALD. Pathologists and clinicians need to be aware of GALD as a cause of FDIU.

Exposure to polycyclic aromatic hydrocarbons and missed abortion in early pregnancy in a Chinese population

Background Polycyclic aromatic hydrocarbons (PAHs) are formed during incomplete burning of fossil fuels, wood, and tobacco products. High PAH exposure has been associated with low birth weight, intrauterine growth restriction, and preterm birth, but little is known about its impact on adverse outcomes in early pregnancy such as in-utero fetal death. Objectives To examine associations between exposure to PAHs and missed abortion in which the embryo has died but a miscarriage has not yet occurred during early pregnancy in a Chinese population in Tianjin. Methods A case–control study was conducted from April to November, 2007 in Tianjin, China. Cases experienced a missed abortion while controls underwent elective abortions before 14 weeks of pregnancy. Eighty-one cases were recruited from four hospitals, with the same number of controls matched on hospital, maternal age (± 8 years), gravidity (1 or >1), and gestational age (± 30 days). Two maternal measures of PAH exposures were obtained based on benzo[ a]pyrene (BaP) DNA adducts in 1) aborted tissues and 2) maternal blood (for a subset of subjects). In addition, proxy measures for PAH exposures from different sources were derived from maternal interviews. Results In conditional logistic regression analyses, we estimated more than 4-fold increase in risk of having experienced a missed abortion in women with above the median levels of blood BaP-DNA adducts (adjusted OR = 4.27; 95% CI, 1.41–12.99); but no increase with adduct levels in aborted tissues (adjusted OR = 0.76; 95% CI, 0.37–1.54). BaP-DNA adduct levels in maternal blood and aborted tissues were poorly correlated ( r = − 0.12; n = 102). Missed abortion risk also was higher among women reporting traffic congestion near the residence, commuting by walking, and performing regular cooking activities during pregnancy. Conclusion High levels of maternal PAH exposures may contribute to an increased risk of experiencing a missed abortion during early pregnancy.

Second trimester listeriosis followed by fetal death in utero (FDIU) : A case report

Listeriosis is an infectious disease caused by Listeria monocytogenes, a gram positive, facultatively anaerobic bacterium. Listeriosis occurs primarily in newborn infants, elderly patients, immunocompromised patients and pregnant women. One third of the patients are pregnant women, and complications of this disease include miscarriage, stillbirth and preterm labor. We experienced a case of listeriosis in a singleton pregnancy at 23 rd week of gestation that presented with fever, chill, lower abdominal pain, backache, and eventually resulted in fetal death in utero. Autopsy results of the stillborn baby, as well as blood and amniotic fluid culture of the mother confirmed Listeria monocytogenes infection. Proper antibiotics therapy thereafter led to clear recovery of the infected mother. We report this case with a brief review of literature.

263: Twin pregnancies with different gender are related with adverse neonatal outcomes in dichorionic twins kyung

ObjectiveThe purpose of this study was to evaluate whether neonatal outcomes are different between newborns of same gender and those of different gender in dichorionic twins.Study designWe studied consecutive 390 dichorionic twin pregnancies (gestational age at delivery ≥24 weeks). Pregnancies complicated by in-utero fetal death or structural anomalies were excluded. Chorionicity was determined by histologic placental examination or gender. The population was subdivided into two groups. Group 1 consisted of 174 twin pairs with different gender and group 2 consisted of 216 twin pairs with same gender. Significant neonatal morbidity was defined as one or more complications including respiratory distress syndrome (RDS), bronchopulmonary dysplasia (BPD), necrotizing enterocolitis, congenital sepsis and brain lesion such as periventricular leukomalacia, intraventricular hemorrhage and cerebral infarction. We compared neonatal mortality and morbidity between two groups. Parametric and nonparametric methods were used as appropriate for statistical analysis.ResultsTwo groups showed similar gestational age at birth. Group 1 had significantly higher rates of neonatal mortality (1.7% vs. 0.2%, p <.05) and significant neonatal morbidity (9.6% vs. 5.6%, p <.05) than group 2. Even after adjustment for gestational age at birth, in vitro fertilization and discordance in birth weight (defined as 25% or more), group 1 had a significantly higher rate of neonatal morbidity than group 2 (RR, 8.58; 95% CI, 2.37-31.02, p <.01).ConclusionOur data suggests that newborns in twin pairs of different gender have adverse neonatal outcomes than those of same gender in dichorionic twins. ObjectiveThe purpose of this study was to evaluate whether neonatal outcomes are different between newborns of same gender and those of different gender in dichorionic twins. The purpose of this study was to evaluate whether neonatal outcomes are different between newborns of same gender and those of different gender in dichorionic twins. Study designWe studied consecutive 390 dichorionic twin pregnancies (gestational age at delivery ≥24 weeks). Pregnancies complicated by in-utero fetal death or structural anomalies were excluded. Chorionicity was determined by histologic placental examination or gender. The population was subdivided into two groups. Group 1 consisted of 174 twin pairs with different gender and group 2 consisted of 216 twin pairs with same gender. Significant neonatal morbidity was defined as one or more complications including respiratory distress syndrome (RDS), bronchopulmonary dysplasia (BPD), necrotizing enterocolitis, congenital sepsis and brain lesion such as periventricular leukomalacia, intraventricular hemorrhage and cerebral infarction. We compared neonatal mortality and morbidity between two groups. Parametric and nonparametric methods were used as appropriate for statistical analysis. We studied consecutive 390 dichorionic twin pregnancies (gestational age at delivery ≥24 weeks). Pregnancies complicated by in-utero fetal death or structural anomalies were excluded. Chorionicity was determined by histologic placental examination or gender. The population was subdivided into two groups. Group 1 consisted of 174 twin pairs with different gender and group 2 consisted of 216 twin pairs with same gender. Significant neonatal morbidity was defined as one or more complications including respiratory distress syndrome (RDS), bronchopulmonary dysplasia (BPD), necrotizing enterocolitis, congenital sepsis and brain lesion such as periventricular leukomalacia, intraventricular hemorrhage and cerebral infarction. We compared neonatal mortality and morbidity between two groups. Parametric and nonparametric methods were used as appropriate for statistical analysis. ResultsTwo groups showed similar gestational age at birth. Group 1 had significantly higher rates of neonatal mortality (1.7% vs. 0.2%, p <.05) and significant neonatal morbidity (9.6% vs. 5.6%, p <.05) than group 2. Even after adjustment for gestational age at birth, in vitro fertilization and discordance in birth weight (defined as 25% or more), group 1 had a significantly higher rate of neonatal morbidity than group 2 (RR, 8.58; 95% CI, 2.37-31.02, p <.01). Two groups showed similar gestational age at birth. Group 1 had significantly higher rates of neonatal mortality (1.7% vs. 0.2%, p <.05) and significant neonatal morbidity (9.6% vs. 5.6%, p <.05) than group 2. Even after adjustment for gestational age at birth, in vitro fertilization and discordance in birth weight (defined as 25% or more), group 1 had a significantly higher rate of neonatal morbidity than group 2 (RR, 8.58; 95% CI, 2.37-31.02, p <.01). ConclusionOur data suggests that newborns in twin pairs of different gender have adverse neonatal outcomes than those of same gender in dichorionic twins. Our data suggests that newborns in twin pairs of different gender have adverse neonatal outcomes than those of same gender in dichorionic twins.

627: In pregnancies affected by down syndrome abnormal umbilical artery doppler flow can identify those at risk for fetal death

Fetuses with Down Syndrome (DS) are known to be at increased risk for in utero fetal death (IUFD). If IUFD occurs, it is reported to occur in the 2nd and 3rd trimester. Our aim was to study the role of umbilical artery flow studies in predicting the poor fetal outcome.

Antenatal detection and impact on outcome of congenital diaphragmatic hernia: A 12-year experience in Auvergne (France)

Objective To evaluate the detection rate of prenatal diagnosis and its impact on outcome in congenital diaphragmatic hernia (CDH). Study design We retrospectively studied 51 cases of CDH registered in the Auvergne area from January 1992 to December 2003 (Birth Defect Registry of Auvergne, Institut Européen des Génomutations). Our main outcome measurements were the detection rate of prenatal diagnosis, the incidence and types of associated anomalies and outcome (termination of pregnancy, in utero fetal demise, neonatal death, survival at the time of registration). Results Twenty-nine cases of isolated CDH were identified of which 13 were detected prenatally (45%) at a mean gestational age of 26.1 weeks and 22 cases of CDH with associated anomalies with prenatal diagnosis of CDH or any associated anomaly in 16 (73%; p = 0.03) at a mean gestational age of 23.9 weeks. In the prenatally detected group (29 cases), there was 1 (3%) in utero fetal death (IUFD), 17 (59%) terminations of pregnancy (TOP) and 11 (38%) live births with early neonatal death in 7 (24%) cases despite delivery in a tertiary care centre in 10/11 cases (four survivors = 14%). Most of the undetected cases were isolated CDH (16/22 = 73%) of which 1 (5%) was a stillborn and 21 (95%) live births with 17 survivors (77%) although 15/21 (71%) were not born at the tertiary care centre ( p = 0.001). The overall survival rate was 41% with a large variability depending on associated anomalies and prenatal diagnosis ( p < 0.0001) (prenatally detected cases: 3/13 (23%) isolated CDH and 1/16 (6%) CDH with associated anomalies; undetected cases: 13/16 (81%) isolated CDH and 4/6 (67%) CDH with associated anomalies). Conclusion Prenatal diagnosis of CDH leads to the delivery of affected babies in tertiary care centres but it remains a challenge in particular for isolated CDH cases and it is associated with a lower survival rate. Associated anomalies contribute to prenatal detection, are related to a higher TOP rate but do not facilitate the detection of diaphragmatic defect per se.

First trimester fetal death in utero: do assisted reproductive techniques increase the chromosome abnormality rate?

Objective: It is known that >60% of spontaneous abortions at <12wks are aneuploid. In this study we analyzed chromosomes in spontaneously aborted material from 29 ART pregnancies and 69 naturally occurring pregnancies, all of which resulted in fetal death in utero (FDIU) in the first 12 weeks of pregnancy. The objective of the study was to compare the frequency and types of chromosome abnormalities in these two patient populations.

Occasional Review: Systemic Lupus Erythematosus and Pregnancy at the Royal Women's Hospital, Brisbane 1979–1989

Summary: : The management and obstetric outcome of 17 patients with systemic lupus erythematosus (SLE) complicating 42 pregnancies is presented. Similar to world figures there was a 14.3% incidence of therapeutic abortion, a 4.8% incidence of ectopic pregnancy, a 16.7% incidence of spontaneous abortion, a 23.8% incidence of prematurity, a 4.8% incidence of fetal death in utero (FDIU) and a 9.5% incidence of intrauterine growth retardation (IUGR). In patients with antiphospholipid antibodies the obstetric outcome was significantly worse. Pregnancies complicated by preexisting renal compromise all concluded with an adverse outcome to the conceptus. In light of the experiences at the Royal Women's Hospital and a review of the world literature, the need for a standardized approach to SLE in pregnancy and more importantly the need for a large, prospective randomized trial of low dose aspirin in these pregnancies is highlighted.

Cocaine-Associated Fetal Death In Utero

Cocaine and its principle metabolite benzoylecgonine were quantitated in blood and liver in six cocaine-related deaths within the Hennepin County Medical Examiner's jurisdiction. Postmortem blood cocaine and benzoylecgonine concentrations ranged from 0 to 5.6 mg/L and 0.6 to 18.7 mg/L respectively. Postmortem liver concentrations ranged from 0 to 5.0 mg/kg and 0.4 to 24.1 mg/kg, respectively. All cases had benzoylecgonine concentrations greater than cocaine concentrations. Most alarming were the findings regarding the cocaine and benzoylecgonine concentrations in the case of a dead pregnant woman. The amniotic fluid cocaine and benzoylecgonine concentrations of 3.3 mg/L and 1.6 mg/L displayed at parent drug to metabolite ratio greater than 1.0 compared to the blood (0.30) and liver (0.21) ratios. This was likely indicative of very recent exposure.

Fetal Death in Utero and Cocaine Abuse

Fetal Death in Utero and Cocaine Abuse

Maternal Deaths Associated With Antepartu Fetal Death in Utero, United States, 1972 to 1978

Maternal Deaths Associated With Antepartu Fetal Death in Utero, United States, 1972 to 1978

Third Trimester Induction of Labor with Fetal Death in Utero

Labor was induced in 64 women in the third trimester, after antepartum fetal death. In 26 patients, hypertonic saline solution was instilled into the uterus; in 24, surgical rupture of the membranes, followed by oxytocin, was tried, and in 14, induction was by amniotomy only. A definite advantage of the last two methods was shown, the mean induction delivery interval being 22.55, 8.96 and 7.20 hours, respectively. Considering also the possible dangers of hypertonic saline solution, the simple method of amniotomy is preferred.

Further Experience with Amniography in Fetal Death in Utero

Further Experience with Amniography in Fetal Death in Utero

Hemorrhagic Diathesis with Hypofibrinogenemia following Fetal Death in Utero

Hemorrhagic Diathesis with Hypofibrinogenemia following Fetal Death in Utero