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3 - The fetus less than 15 weeks gestation

Published online by Cambridge University Press:  05 September 2014

By
L. Cesar Peres  and
Christina Vogt
Edited by
Marta C. Cohen  and
Irene Scheimberg
L. Cesar Peres
Affiliation:
Sheffield Children’s Hospital NHS Foundation Trust, Sheffield, UK
Christina Vogt
Affiliation:
Norwegian University of Science and Technology
Marta C. Cohen
Affiliation:
Sheffield Children’s Hospital
Irene Scheimberg
Affiliation:
Barts and the London NHS Trust, London
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Summary

Background

Examination of fetuses of less than 15 weeks gestation poses problems not encountered in older fetuses. Structures are small, organs may be difficult to find, and also difficult to evaluate. This represents a particular challenge. Also, the approach will differ depending on whether the fetus is a fresh abortus, a macerated intrauterine fetal death (IUFD), or the result of termination of pregnancy (TOP) due to a congenital anomaly and/or chromosome aberration. In all cases it is important to remember that the examination is not complete without the placenta. Ballantyne’s words, “To examine a fetus without its placenta is like going to sea without a chart,” are always valid [1]. This applies particularly to IUFDs, where the placenta is likely to play an important role.

Obstetricians and general pathologists are often not fully aware of the importance of autopsy of even small fetuses. A properly conducted autopsy may have wide consequences for the parents and for the clinicians or geneticists who have the task of informing and eventually counseling the parents on future pregnancies. Most parents will want to know why the fetus died or was aborted, and most of all, they want to know if there is a similar risk in future pregnancies. For the clinician it is more rewarding to talk with the parents when they have concrete information and can explain what happened. In cases where there is need for genetic counseling, the geneticist will benefit from access to external description and detailed photographs.

Type
Chapter
Information
The Pediatric and Perinatal Autopsy Manual , pp. 47 - 61
Publisher: Cambridge University Press
Print publication year: 2000

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References

Ballantyne, J. W.. Manual of Antenatal Pathology and Hygiene, Edinburgh, W. Green, 1904.Google Scholar
Becker, M. J. and Becker, A. E.. Pathology of Late Fetal Stillbirth, Edinburgh, Churchill Livingstone, 1989.Google Scholar
Silver, R. M.. Fetal death. Obstet Gynecol 2007; 109: 153–67.CrossRefGoogle ScholarPubMed
Johnson, R. V.. Mayo Clinic Complete Book of Pregnancy and Baby’s First Year. New York, William Morrow and Co. Inc., 1994.Google Scholar
Bukowski, R., Carpenter, M., Conway, D., et al. Causes of death among stillbirths: Stillbirth Collaborative Research Network Writing Group. JAMA 2011; 306: 2459–68.Google Scholar
Alberman, E. and Creasy, M.. Frequency of chromosomal abnormalities in miscarriages and perinatal deaths. J Med Genet 1977; 14: 313–15.CrossRefGoogle ScholarPubMed
Hassold, T.. Chromosome abnormalities in human reproductive wastage. Trends Genet 1986; 2: 105–10.CrossRefGoogle Scholar
Dôria, S., Carvalho, F., Ramalho, C., et al. An efficient protocol for the detection of chromosomal abnormalities in spontaneous miscarriages or foetal deaths. Eur J Obstet Gynecol Reprod Biol 2009; 147: 144–50.CrossRefGoogle ScholarPubMed
Bateman, B. T. and Simpson, L. L.. Higher rate of stillbirth at the extremes of reproductive age: a large nationwide sample of deliveries in the United States. Am J Obstet Gynecol 2006; 195: 840–5.CrossRefGoogle Scholar
Kristensen, J., Vestergaard, M., Wisborg, K., et al. Pre-pregnancy weight and the risk of stillbirth and neonatal death. Br J Obstetr Gynaecol 2005; 112: 403–8.CrossRefGoogle ScholarPubMed
Goldenberg, R. L. and Thompson, C. B. S.. The infectious origins of stillbirth. Am J Obstet Gynecol 2003; 189: 861–73.CrossRefGoogle ScholarPubMed
Dunn, D., Wallon, M., Peyron, F., et al. Mother-to-child transmission of toxoplasmosis: risk estimates for clinical counselling. Lancet 1999; 353: 1829–33.CrossRefGoogle ScholarPubMed
Isaksen, C. V., Eik-Nes, S. H., Blaas, H.-G., et al. A correlative study of prenatal ultrasound findings and postmortem examination in fetuses and infants with an abnormal karyotype. Ultrasound Obstet Gynecol 2000; 16: 37–45.CrossRefGoogle ScholarPubMed
Gelehrter, T. D. and Collins, F. S.. Principles of Medical Genetics. Baltimore, Williams & Wilkins, 1990.Google Scholar
Wapner, R. J. and Lewis, D.. Genetics and metabolic causes of stillbirth. Semin Perinatol 2002; 26: 70–4.CrossRefGoogle ScholarPubMed
Gillerot, Y., Jauniaux, E., van Maldergem, L., Fourneau, C.. Pathogenesis of human malformations. In: Barnea, E. R., Hustein, J. and Jauniaux, E., eds., The First Twelve Weeks of Gestation. Berlin, Springer Verlag, 1992.Google Scholar
Woodward, P., Sohaey, R., Harris, D., et al. Postmortem fetal MR imaging: comparison with findings at autopsy. Am J Roentgenol 1997; 168: 41–6.CrossRefGoogle ScholarPubMed
Langer, B., Choquet, P., Ravier, S., et al. Low-field dedicated magnetic resonance imaging: a potential tool for assisting perinatal autopsy. Ultrasound Obstet Gynecol 1998; 12: 271–5.CrossRefGoogle ScholarPubMed
Cobben, J. M., Essed, C. E., Hirdes, J., Kraayenbrink, R. A., and Van der Veen, A.. Fluorescence in situ hybridization on formalin fixed fetal tissue in the diagnosis of chromosomal syndromes. Genet Couns 1994; 5: 141–5.Google Scholar
Isaksen, C., Ytterhus, B., and Skarsvag, S.. Detection of trisomy 18 on formalin-fixed and paraffin-embedded material by fluorescence in situ hybridization. Pediatr Dev Pathol 2000, 3: 249–55.CrossRefGoogle ScholarPubMed
Keeling, J. W.. Fetal Pathology. London, Churchill-Livingstone, 1994.Google Scholar
Siebert, J. R.. Perinatal, fetal and embryonic autopsy. In Gilbert-Barness, E., eds., Potter’s Pathology of the Fetus, Infant and Child, 2nd edition. Philadelphia, Elsevier Inc., 2007, 695–739.Google Scholar
England, M. A.. A Colour Atlas of Life Before Birth: Normal Fetal Development. London, Wolfe Medical Publishing Ltd, 1990.Google Scholar
Gilbert-Barness, E. and Ebich-Spicer, D.. Embryo and Fetal Pathology: Color Atlas with Ultrasound Correlation. Cambridge, Cambridge University Press, 2006.Google Scholar
Peres, L. C., Bekhit, M., and Roobin, J.. A Tetralogy of Fallot associated with a stenotic pulmonary valve and agenesis of the ductus arteriosus in a 13-week-old fetus: the role of post-mortem examination. Pediatr Dev Pathol 2012; 15: 240–4.CrossRefGoogle Scholar
Peres, L. C. and Taylor, D.. Overestimation of umbilical cord coiling index with segmental versus total length assessment. Pediatr Dev Pathol 2012; 15: 303–5.CrossRefGoogle ScholarPubMed
van Dijk, C. C., Franx, A., de Laat, M. W. M., et al. The umbilical cord index in normal pregnancy. J Mat Fetal Neonatal Med 2002; 11: 280–3.CrossRefGoogle Scholar
Peres, L. C.. Splitting of the umbilical cord in a 13-week-old fetus. Pediatr Dev Pathol 2012; 15: 62–4.CrossRefGoogle Scholar
Fritsch, M. K.. Reproductive system. In Gilbert-Barness, E., eds., Potter’s Pathology of the Fetus, Infant and Child, 2nd edition. Philadelphia, Elsevier Inc., 2007, 1375–450.Google Scholar
Rushton, D. I.. Examination of products of conception from previable human pregnancies. J Clin Pathol 1981; 34: 819–35.CrossRefGoogle ScholarPubMed
Maroun, L. L. and Graem, N.. Autopsy standards of body parameters and fresh organ weights in nonmacerated and macerated human fetuses. Ped Dev Pathol 2005; 8: 204–17.CrossRefGoogle ScholarPubMed
Siewers, R. D., Ettedgni, J., Pahl, E., et al. Coarctation of the aortic arch: will the arch grow?Ann Thorac Surg 1991; 52: 608–14.CrossRefGoogle ScholarPubMed
Peres, L. C., Sethuraman, C., Al-Adnani, M., and Cohen, M. C.. Necrotic epithelial cells in proximal renal tubules of 2nd trimester fetuses: is this “acute tubular necrosis”?Int J Clin Exp Pathol 2012; 5: 326–30.Google ScholarPubMed
Roberts, D. J. and Genest, D.. Cardiac histologic pathology characteristic of trisomies 13 and 21. Hum Pathol 1992; 23: 1130–40.CrossRefGoogle ScholarPubMed
Ernst, L. M., Ruchelli, E. D., and Huff, D. S.. Color Atlas of Fetal and Neonatal Histology. New York, Springer Science-Business Media, 2011.CrossRefGoogle Scholar
Baergen, R.. Manual of Benirschke and Kaufmann’s Pathology of the Human Placenta. New York, Springer, 2004.Google Scholar
Lurie, S., Feinstein, M., and Mamet, Y.. Human fetal–placental weight ratio in normal singleton near-term pregnancies. Gynecol Obstet Invest 1999; 48: 155–7.CrossRefGoogle ScholarPubMed
Tellefsen, C. H. and Vogt, C.. How important is placental examination in cases of perinatal deaths?Pediatr Dev Pathol 2011; 14: 99–104.CrossRefGoogle ScholarPubMed
Benirschke, K., Kaufmann, P., and Baergen, R.. Anatomy and Pathology of the umbilical cord. In Benirschke, K., Kaufmann, R., and Baergen, R., eds., Pathology of the Human Placenta, 5th edition. New York, Springer, 2006, 380–51.Google Scholar
Kraus, F. T., Redline, R. W., Gersell, D. J., et al. Embryonic development and pathology of the umbilical cord. In Kraus, F. T., Redline, R. W., Gersell, D. J., et al., eds., Placental Pathology: Atlas of Non-tumor Pathology. Washington, DC, American Registry of Pathology, 2004, 179–205.Google Scholar
Creasy, M. R., Crolla, J. A., and Alberman, E. D.. A cytogenetics study of human spontaneous abortion using banding techniques. Hum Genet 1976; 31: 177–96.CrossRefGoogle Scholar
Balasubramanian, M., Peres, L. C., and Pelly, D.. Confined fetal trisomy 11 mosaicism with bilateral renal agenesis: co-incidence or new association?Clin Dysmorphol 2011; 20: 47–9.CrossRefGoogle ScholarPubMed
Gardosi, J., Kady, S. M., McGeown, P., Francis, A., and Tonks, A.. Classification of stillbirth by relevant condition at death (ReCoDe): population based cohort study. BMJ 2005; 331: 1113–37.CrossRefGoogle ScholarPubMed

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