Stillborn Fetuses Research Articles

Improved farrowing rate using intrauterine insemination in sows

Intrauterine insemination (IUI), a technique that uses a lower number of spermatozoa than conventional artificial insemination (CAI), could contribute to improve reproductive efficiency of boars. However, since some field trial reports show suboptimal performance for IUI, it is necessary to continue evaluating and standardizing this technique. In this work, the use of fixed reduced sperm amounts and doses volumes for IUI respect to CAI using the same semen samples was assessed. The results show an increase in the farrowing rate using IUI vs CAI (84.80 ± 0.36 vs 71.44 ± 2.63, P<0.05). Parameters such as litter size, live piglets/litter, stillborn or mummified fetuses were analyzed as well and showed non-significant differences between techniques. Statistical positive correlation analyses showed a positive correlation between live piglets/litter and stillborn piglets and between stillborn and total number of piglets, only for CAI. In addition, the economic analysis showed a positive impact on the productivity of the farm, and possibly of the region, by lowering costs using IUI instead of CAI. In conclusion, the intrauterine insemination had a positive impact on the reproductive performance and on the economic parameters of porcine production.

MORPHOLOGICAL AND DEVELOPMENTAL STUDY OF HUMAN FETAL THYMUS GLAND IN KUMAON REGION

Introduction: A cross sectional study was conducted to observe morphological and developmental changes occurring in thymus gland at various gestational age among human fetuses. The morphometric measurements of thymus is useful in calculating size as intrauterine growth retardation (IUGR) and cellular immune deficiency of infant is associated with a significant decrease in fetal thymic size. Materials & Methods: This study was carried on medically aborted and stillborn fetuses (n=31; F=21, M=10), which were obtained from Dr. Sushila Tiwari Memorial Hospital, Haldwani, (Uttarakhand,) with due consent of parents. Fetuses were preserved in 10% formalin. Thymic gland was dissected out to observe its weight, length and thickness. Results: Thymus glands were located in superior mediastinum. On gross examination, they were of greyish pink to greyish brown in colour. Most of the glands were bilobed and few were irregular in shape. There was progressive increase in all morphometric dimensions of thymus in relation to gestational age. Growth of right lobe of thymus was comparatively more than of left lobe. Conclusion: Thymic morphometric parameters in relation to gestational age can be used as reference values in imaging studies in the prenatal and in initial perinatal stages, so we could compare the normal morphology with that of in IUGR and immune deficiency.

Added value of chromosomal microarray analysis over conventional karyotyping in stillbirth work-up: systematic review and meta-analysis.

To assess the added value of chromosomal microarray analysis (CMA) over conventional karyotyping to assess the genetic causes in stillbirth. To identify relevant studies, published in English or Spanish and without publication time restrictions, we performed a systematic search of PubMed, SCOPUS and ISI Web of Science databases, The Cochrane Library and the PROSPERO register of systematic reviews, for case series of fetal loss ≥ 20 weeks of gestation, with normal or suspected normal karyotype, undergoing CMA and with at least five subjects analyzed. To investigate quality, two reviewers evaluated independently the risk of bias using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. For the meta-analysis, the incremental yield of CMA over karyotyping was assessed by single-proportion analysis using a random-effects model (weighting by inverse variance). We assessed heterogeneity between studies and performed a sensitivity analysis and a subgroup analysis of structurally abnormal (malformed or growth-restricted) and normal fetuses. Included in the meta-analysis were seven studies involving 903 stillborn fetuses which had normal karyotype. The test success rate achieved by conventional cytogenetic analysis was 75%, while that for CMA was 90%. The incremental yield of CMA over conventional karyotyping based on the random-effects model was 4% (95% CI, 3-5%) for pathogenic copy-number variants (pCNVs) and 8% (95% CI, 4-17%) for variants of unknown significance. Subgroup analysis showed a 6% (95% CI, 4-10%) incremental yield of CMA for pCNVs in structurally abnormal fetuses and 3% (95% CI, 1-5%) incremental yield for those in structurally normal fetuses. The pCNV found most commonly was del22q11.21. CMA, incorporated into the stillbirth work-up, improves both the test success rate and the detection of genetic anomalies compared with conventional karyotyping. To achieve a genetic diagnosis in stillbirth is particularly relevant for the purpose of counseling regarding future pregnancies. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.

Analysis of Causes of Death and Related Factors of 102 Perinatal Infants in Chongqing.

To analyze the causes of perinatal death and related factors from the perspective of forensic medicine, and to provide references for reducing perinatal mortality and guidance for forensic identification. A retrospective analysis was performed on 102 cases of perinatal autopsy with clinical data from the Department of Forensic Medicine of Chongqing Medical University in 2004-2016. Of the 102 cases of perinatal deaths, 66 （64.71%） were neonatal deaths, 24 （23.53%） were stillborn foetuses, and 12 （11.76%） were stillbirths. Among the 66 neonatal death cases, 39 （59.09%） died within 1 d, 19 （28.79%） died within 1-3 d, and 8 （12.12%） died within >3-7 d of birth. The top 3 causes of neonatal death were pulmonary diseases, congenital malformation, umbilical cord and placental abnormalities. The causes of stillborn foetus and stillbirth were mainly umbilical cord and placental abnormalities, and intrauterine asphyxia. Pulmonary diseases, umbilical cord and placental abnormalities, and congenital malformations are the main causes of perinatal death. In order to reduce the perinatal mortality, pre-pregnancy examination and prenatal care should be strengthened, and the knowledge of pregnancy care should be popularized.

First report of caprine abortions due to Chlamydia abortus in Argentina

Infectious abortions of goats in Argentina are mainly associated with brucellosis and toxoplasmosis. In this paper, we describe an abortion outbreak in goats caused by Chlamydia abortus. Seventy out of 400 goats aborted. Placental smears stained with modified Ziehl‐Neelsen stain showed many chlamydia‐like bodies within trophoblasts. One stillborn fetus was necropsied and the placenta was examined. No gross lesions were seen in the fetus, but the inter‐cotyledonary areas of the placenta were thickened and covered by fibrino‐suppurative exudate. The most consistent microscopic finding was found in the placenta and consisted of fibrinoid necrotic vasculitis, with mixed inflammatory infiltration in the tunica media. Immunohistochemistry of the placenta was positive for Chlamydia spp. The results of polymerase chain reaction targeting 23S rRNA gene performed on placenta were positive for Chlamydia spp. An analysis of 417 amplified nucleotide sequences revealed 99% identity to those of C. abortus pm225 (GenBank AJ005617) and pm112 (GenBank AJ005613) isolates. To the best of our knowledge, this is the first report of abortion associated with C. abortus in Argentina.

Parameters for estimating the time of death at perinatal autopsy of stillborn fetuses: a systematic review.

Stillbirth is defined by the WHO as birth of a fetus with no vital signs, at or over 28weeks of pregnancy age. The estimation of time of death in stillbirth appears crucial in forensic pathology. However, there are no validated methods for this purpose. To perform a systematic review of the available literature regarding the estimation of the time of death in stillborn fetuses, in terms of hours or days. Electronic databases were searched from their inception to August 2018 for relevant articles. Macroscopic, histologic, and radiologic parameters were evaluated. Nine studies with 664 stillborns were included. The evaluation of extent and location of fetal maceration signs showed good accuracy in estimating the time of death; by contrast, a dichotomous assessment of maceration (present vs absent) was found to be unreliable in a subsequent study. Histologic assessment of the loss of nuclear basophilia in fetal and placental tissues showed excellent accuracy; an "autolysis equation" was proposed to achieve an even higher accuracy in fetuses who had been dead for < 24h. Magnetic resonance imaging of the lung parenchyma, pleural fluids, and brain parenchyma could estimate the death-to-autopsy time, but the results appeared weak and conflicting. Pathologic examination, based on the assessment of maceration, and even more of the loss of nuclear basophilia, may be a reliable method to estimate the time of death in stillborn fetuses. Further studies should be encouraged to validate these results. Imaging techniques have not yet found application in this field.

“Soothing My Child's Soul and My Own”: Dealing with Pregnancy Loss in Postcommunist Romania

AbstractIn Romania—where induced abortions were legally prohibited during communism and are now morally condemned by many—those who lose a pregnancy against their will have long been regarded with suspicion, confronted with a sense of culpability, and surrounded by silence. This ambiguity is reflected in the local terminology and the perceived etiology of loss. In this article, which is based on 15 months of fieldwork between 2012 and 2015, I illustrate the various meanings and manifestations of a silenced sense of culpability around involuntary pregnancy loss in the lives of women from Bucharest and a small town in Central Romania. I also show how many of these women attempt to break the silence around their lost fetuses and carve out a personal space of commemoration and consolation. Their informal use of forbidden religious rituals paradoxically allows them to confirm the existence of their lost little ones and to position themselves as caring, rather than culpable, mothers. [pregnancy loss, commemoration, culpability, postcommunist Romania]

Psychosocial Implications of Stillborn Babies on Mother and Family: A Review from Tertiary Care Infirmary in India.

When a mother loses a baby after the period of viability, there is no way to fathom her grief, neither any words, nor an explanation. It is an unexpected event. Stillbirth presents a situation where the early activation of the grief process primarily in mother is exacerbated by the circumstances surrounding the loss. It thus becomes imperative for the healthcare providers to evaluate the significance of parent's perception on the loss and the factors contributing to it before the initiation of therapy. To evaluate the psychosocial impact of stillbirth among mothers and its contributing factors. A WHO-funded prospective study was conducted in VMMC and Safdarjung Hospital from September 2015 to August 2016 on all women who gave birth to a stillborn baby, using a questionnaire based on EPDS, after taking their written informed consent. Data were entered on the predesigned proforma and analyzed after applying Chi-square test, keeping a null hypothesis value of 15% for all the variables. Out of the 709 women who delivered stillborn babies, 645 respondents, who willingly consented to participate, were included in the study. There was a significant relationship between psychosocial impact after perinatal loss and support from caregiver and family. Mothers with stillborn fetuses should be screened for psychosocial impact and offered support when needed. Appropriate counseling by healthcare providers and continued psychosocial and emotional support by family members must be provided.

Zika-virus-infected human full-term placental explants display pro-inflammatory responses and undergo apoptosis.

Zika virus (ZIKV) is a flavivirus that has been highly correlated with the development of neurological disorders and other malformations in newborns and stillborn fetuses after congenital infection. This association is supported by the presence of ZIKV in the fetal brain and amniotic fluid, and findings suggest that infection of the placental barrier is a critical step for fetal ZIKV infection in utero. Therefore, relevant models to investigate the interaction between ZIKV and placental tissues are essential for understanding the pathogenesis of Zika syndrome. In this report, we demonstrate that explant tissue from full-term human placentas sustains a productive ZIKV infection, though the results depend on the strain. Viral infection was found to be associated with pro-inflammatory cytokine expression and apoptosis of the infected tissue, and these findings confirm that placental explants are targets of ZIKV replication. We propose that human placental explants are useful as a model for studying ZIKV infection ex vivo.

Fetal pancreatic Langerhans islets size in pregnancies with metabolic disorders

Objective: Metabolic disorders are a pandemic and increasing health problem. Women of childbearing age may also be affected, thus an abnormal metabolism may interfere with pregnancy short- and long-term outcomes, harming both mother and child. In the context of an abnormal maternal and intrauterine metabolic milieu the development of fetal organs, including pancreas, may be affected.Aim: To investigate the effects of pregnancy metabolic disorders on the morphology of pancreatic Langerhans islets in human late-third trimester stillborn fetuses.Methods: Samples from fetal pancreas underwent a quantitative histological evaluation to detect differences between pregnancy with (cases, n = 9) or without (controls, n = 6) abnormal metabolism.Results: Results show that the islets size increases in fetuses from dysmetabolic pregnancies and that this increment is related to both beta-cell hyperplasia and hypertrophy. Moreover, according to pregnancy and fetal metabolic disorders, a threshold of abnormal size of the islets has been identified. Above this threshold the size of fetal pancreatic Langerhans islets should be considered excessively increased.Conclusion: The study suggests that an accurate fetal pancreas analysis supplies an important tool in stillborn fetus, to discover metabolic disturbances that should be kept in mind and managed in future pregnancies.

Generation of Human Induced Pluripotent Stem Cells Using a Defined, Feeder-Free Reprogramming System.

Human induced pluripotent stem cells (hiPSCs) offer great opportunities for the study of human development and disease modeling and have enormous potential for use in future clinical cell-based therapies. However, most current systems to create hiPSCs often expose the cells to animal feeder layers or xenogeneic reagents; this raises safety concerns about using hiPSC-derived cells for therapeutic purposes. Here, we describe protocols to generate hiPSCs without exposing the cells to xenogeneic materials that uses a defined, feeder-free reprogramming system. With this method, we were able to successfully reprogram not only patient-derived peripheral blood mononuclear cells but also amniocytes from the amniotic fluid of stillborn fetuses using two independent reprogramming platforms. Importantly, hiPSCs generated in this fashion expressed pluripotent markers and had normal karyotypes. The protocols allowed us to generate and culture hiPSCs under Good Manufacturing Practice-like conditions, a necessary step for the future clinical application of these cells. © 2018 by John Wiley & Sons, Inc.

Lymph drainage of the upper limb and mammary region to the axilla: anatomical study in stillborns.

We studied the lymphatic drainage of the upper limb and mammary region directing to the axilla to investigate whether independent pathways can be observed or whether anastomoses and shared drainage occur between them. This analysis aimed to assess the safety of axillary reverse mapping (ARM) in breast cancer treatment and to understand the development of lymphedema after sentinel lymph node biopsy (SLNB) alone. Seven unfixed stillborn fetuses were injected with a modified Gerota mass in the peri-areolar area, palm and dorsum of the hands, formalin fixed, and then submerged in 10% hydrogen peroxide solution. Microsurgical dissection was then performed on the subcutaneous cellular tissue of the upper limb, axillary region, and anterior thorax to expose the lymphatic vessels and lymph nodes. The dye injected into the upper limb reached either the lateral axillary group, known to be exclusively responsible for upper limb drainage, or the anterior group, which is typically related to breast drainage. There was great proximity among the pathways and lymph nodes. Communicating lymphatic vessels among these groups of lymph nodes were also found in all studied cases. Lymphedema remains a challenging morbidity in breast cancer treatment. ARM and SLNB aim to avoid unnecessary damage to the lymphatic drainage of the upper limb. However, our anatomical study suggests that ARM may have potential oncological risks because preserved lymph nodes may harbor malignant cells due their proximity, overlapping drainage pathways, and connecting lymph vessels among lymph nodes.

Toxicological and histological analyses for a stillborn delivered by a mother under methadone maintenance therapy

Based on autopsy findings and toxicological results, it was ascertained whether chronic fetal exposure to methadone (MTD) could have caused intrauterine death of a fetus born to a mother under MTD maintenance therapy. Complete fetal autopsy, placental examination and toxicological and histological analyses were performed on a 39-week-old stillborn fetus, whose mother had regularly taken MTD during the pregnancy. The MTD and its main metabolite 2-ethylidene-1,5-dimethyl-3,3-diphenylpyrrolidine (EDDP) were quantified in fetal tissues (brain, liver and kidney) by ultra-high-performance liquid chromatography–tandem mass spectrometry. A fully validated toxicological analytical method was developed. High levels of MTD and EDDP were present in all samples. The EDDP-to-MTD ratios were similar in the liver and kidney, but in the brain, MTD was predominant. Placental histology showed a thrombotic partially organised lesion in the first branches of the umbilical vein (chorionic venous vessels) and delayed villous maturation (DVM) diffusely found in the parenchyma. High levels of MTD and EDDP correlated with chronic fetal exposure to MTD maintenance therapy in pregnancy. Placenta DVM can be associated with the MTD exposure, indirectly affecting glycaemic balance. Fetal cause of death seemed to be related to a global hypoxic-ischemic status as a combination of chronic fetal MTD intoxication, placental DVM and impaired placenta blood flow due to chorionic thrombosis.

Pathology of congenital polycystic kidney disease in a stillborn foetus of fat-Tailed (Dumba) sheep

Polycystic kidney disease (PKD) is comprised of a heterogeneous group of hereditary, developmental and acquired disorders. In the present study, a stillborn female foetus of Dumba sheep was subjected to gross and histopathological examination. On external examination, the foetus was found to be over-weight (3.85 kg) with highly distended abdomen. After opening the carcass, it was found that both kidneys were enlarged, pale yellowish in colour, soft and doughy. After cutting, clear fluid oozed out from the kidneys, numerous fluid filled small cysts (0.3–7.0 mm) were observed diffusely distributed throughout the cortex and medulla. Microscopically, both the kidneys revealed identical histological alterations. The renal parenchyma revealed variable-sized, multiple fusi-form, round and cylindrical cysts. These cysts formed an irregular honeycomb of spaces separated by varying amounts of cellular and stromal components of the interstitium. There was severe dilatation of renal tubules lined by low cuboidal to flattened squamous or flattened columnar epithelium. The glomeruli were sporadic, small, and often hypoplastic or atrophic, located within a dilated Bowman's capsule. Grossly, the liver was enlarged, pale and friable. Microscopically, the hepatocytes revealed vacuolar degenerative changes and multiple small cysts. Characteristic cystic lesions were also observed in cardiac muscles. The present study confirmed congenital cystic kidney disease in fat-tailed (Dumba) sheep similar to autosomal recessive polycystic kidney disease occurring in humans and juvenile polycystic disorders in several animal species.

Spontaneous rupture of an unscarred uterus in a multipara at 32 weeks of gestation: A case report

Uterine rupture is still a public health problem in developing countries. Most spontaneous uterine rupture in this region occurs in unscarred uterus due to prolonged obstructed labor and injudicious use of oxytocics. Antepartum uterine rupture is uncommon; the diagnosis is not always obvious; and maternal, fetal morbidity and mortality are high. A 30-year-old gravida 7 para 5 +1 2alive, at 32 weeks of gestation, booked in a primary healthcare center and presented with sudden onset abdominal pain and vaginal bleeding of 4-h duration. Ultrasound scan revealed a major degree placenta previa; however, intraoperatively an anterior uterine rupture was detected with a fresh still-born male fetus weighing 1,650 g with intact membranes within the abdominal cavity. She had a subtotal hysterectomy performed. This case highlights the occurrence of spontaneous uterine rupture in an unscarred uterus; increased awareness on the need for early presentation enables prompt diagnosis and treatment.

Stillborn Infants: Associated Malformations.

Stillbirth, defined as death of a fetus in utero after 20 weeks of gestation, occurs in 1 to 2% of pregnancies in the United States. Many of these stillborn infants have associated malformations, including chromosome abnormalities, neural tube defects, and malformation syndromes. Other causes are abnormalities of the placenta and maternal conditions, such as pre-eclampsia and obesity. A consecutive sample of malformed stillborn infants can establish the relative frequency and severity of the associated malformations. Stillbirths were identified in the Active Malformations Surveillance Program at Brigham and Women's Hospital (1972-2012). The findings at autopsy, including the findings in the placenta and the results of diagnostic studies, were compiled. One hundred twenty-seven stillborn infants with malformations were identified at autopsy among 289,365 pregnancies, including trisomies 21, 18, and 13; 45,X; triploidy; anencephaly; lower urinary tract obstruction; holoprosencephaly and severe heart defects, such as hypoplastic left heart syndrome and tetralogy of Fallot with pulmonary atresia. The severity of the abnormalities in stillborn infants was more severe than the spectrum of abnormalities identified in live-born infants. An autopsy of the stillborn fetus, including chromosome microarray and an examination of the placenta, can identify the underlying causes of the stillbirth. This review of stillborn fetuses with malformations showed that several different lethal malformations and heart defects are more common than among live-born infants. These postmortem examinations can improve the counseling of the parents about risks in future pregnancies. Birth Defects Research 110:114-121, 2018.© 2018 Wiley Periodicals, Inc.

Does maternal environmental tobacco smoke interact with social-demographics and environmental factors on congenital heart defects?

Congenital heart defects (CHDs) are a major cause of death in infancy and childhood. Major risk factors for most CHDs, particularly those resulting from the combination of environmental exposures with social determinants and behaviors, are still unknown. This study evaluated the main effect of maternal environmental tobacco smoke (ETS), and its interaction with social-demographics and environmental factors on CHDs in China. A population-based, matched case-control study of 9452 live-born infants and stillborn fetuses was conducted using the Guangdong Registry of Congenital Heart Disease data (2004-2014). The CHDs were evaluated by obstetrician, pediatrician, or cardiologist, and confirmed by cardia tomography/catheterization. Controls were randomly chosen from singleton newborns without any malformation, born in the same hospital as the cases and 1:1 matched by infant sex, time of conception, and parental residence (same city and town to ensure sufficient geographical distribution for analyses). Face-to-face interviews were conducted to collect information on demographics, behavior patterns, maternal disease/medication, and environmental exposures. Conditional logistic regression was used to estimate odds ratios and 95% confidence intervals of ETS exposure on CHDs while controlling for all risk factors. Interactive effects were evaluated using a multivariate delta method for maternal demographics, behavior, and environmental exposures on the ETS-CHD relationship. Mothers exposed to ETS during the first trimester of pregnancy were more likely to have infants with CHD than mothers who did not (aOR=1.44, 95% CI 1.25-1.66). We also observed a significant dose-response relationship when mothers were exposed to ETS and an increasing number of risk factors and CHDs. There were greater than additive interactions for maternal ETS and migrant status, low household income and paternal alcohol consumption on CHDs. Maternal low education also modified the ETS-CHD association on the multiplicative scale. These findings may help to identify high-risk populations for CHD, providing an opportunity for targeted preventive interventions.

Efficient generation of P53 biallelic knockout Diannan miniature pigs via TALENs and somatic cell nuclear transfer

BackgroundPigs have many features that make them attractive as biomedical models for various diseases, including cancer. P53 is an important tumor suppressor gene that exerts a central role in protecting cells from oncogenic transformation and is mutated in a large number of human cancers. P53 mutations occur in almost every type of tumor and in over 50% of all tumors. In a recent publication, pigs with a mutated P53 gene were generated that resulted in lymphoma and renal and osteogenic tumors. However, approximately 80% of human tumors have dysfunctional P53. A P53-deficient pig model is still required to elucidate.MethodsTranscription activator-like effector nucleases (TALENs) were designed to target porcine P53 exon 4. The targeting activity was evaluated using a luciferase SSA recombination assay. P53 biallelic knockout (KO) cell lines were established from single-cell colonies of fetal fibroblasts derived from Diannan miniature pigs followed by electroporation with TALENs plasmids. One cell line was selected as the donor cell line for somatic cell nuclear transfer (SCNT) for the generation of P53 KO pigs. P53 KO stillborn fetuses and living piglets were obtained. Gene typing of the collected cloned individuals was performed by T7EI assay and sequencing. Fibroblast cells from Diannan miniature piglets with a P53 biallelic knockout or wild type were analyzed for the P53 response to doxorubicin treatment by confocal microscopy and western blotting.ResultsThe luciferase SSA recombination assay revealed that the targeting activities of the designed TALENs were 55.35-fold higher than those of the control. Eight cell lines (8/19) were mutated for P53, and five of them were biallelic knockouts. One of the biallelic knockout cell lines was selected as nuclear donor cells for SCNT. The cloned embryos were transferred into five recipient gilts, three of them becoming pregnant. Five live fetuses were obtained from one surrogate by caesarean section after 38 days of gestation for genotyping. Finally, six live piglets and one stillborn piglet were collected from two recipients by caesarean section. Sequencing analyses of the target site confirmed the P53 biallelic knockout in all fetuses and piglets, consistent with the genotype of the donor cells. The qPCR analysis showed that the expression of the P53 mRNA had significant reduction in various tissues of the knockout piglets. Furthermore, confocal microscopy and western blotting analyses demonstrated that the fibroblast cells of Diannan miniature piglets with a P53 biallelic knockout were defective in mediating DNA damage when incubated with doxorubicin.ConclusionTALENs combined with SCNT was successfully used to generate P53 KO Diannan miniature pigs. Although these genetically engineered Diannan miniature pigs had no tumorigenic signs, the P53 gene was dysfunctional. We believe that these pigs will provide powerful new resources for preclinical oncology and basic cancer research.

An Unusual Case of Ruptured Uterus Associated With Placenta Abruption: Case Report

Association of abruption of placenta and ruptured uterus is extremely rare, there were only a few cases described in the past. A 24 year-old woman, G2P1 L0 with history of previous Cesarean Section for obstructed labour and now at 7 months of pregnancy, presented with features of acute abdomen with severe anemia. Her pulse rate was 136 per minute, temperature 36.1o C., respirations 28 per minute, blood pressure 96/50 mm. of Hg. Height of uterus 28 weeks, had tenderness and rigidity over the upper abdomen. She was suspected to have Haemoperitoneum due to ruptured uterus, and laparotomy was performed under IV Ketamine as provision of general anaesthesia was unavailable. Intra-operative findings were Haemoperitoneum, recovery of huge amount of clots from peritoneal cavity, Posterior fundal rupture with intact amniotic sac. A fresh stillborn fetus was delivered from the intact amniotic cavity with clear liquor through the rupture site followed by repair of the rent. She received blood transfusion and recovered without any complication. Laparotomy allowed us to discover this unusual presentation in this patient.

The occurrence of porcine circovirus 3 without clinical infection signs in Shandong Province.

SummaryPorcine circovirus type 3 (PCV3) was detected in Shandong, China. One hundred and thirty‐two of 222 (59.46%) samples were PCV3 positive, while 52 of 132 (39.39%) samples were co‐infected with PCV2. There were no clinical signs of infection in either multiparous sows or live‐born infants. Two strains of PCV3 were indentified from natural stillborn foetuses. Phylogenetic analysis showed the two strains of PCV3 are 96% identical to the known PCV3/Pig/USA (KX778720.1, KX966193.1 and KX898030.1) and closely related to Barbel Circovirus. Further studies of the epidemiology of PCV3 and the co‐infection with PCV2 are needed.