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The Journal of Maternal-fetal &... Dec 2022Infection is considered a leading cause of fetal death, responsible for approximately 20% of cases. Such estimates are derived from the frequency of acute histological...
Infection is considered a leading cause of fetal death, responsible for approximately 20% of cases. Such estimates are derived from the frequency of acute histological chorioamnionitis and funisitis in cases of fetal death rather than direct detection of microorganisms in the fetal compartment. We report a case of clinically unexplained fetal death at 38 weeks of gestation in an uncomplicated pregnancy resulting in delivery of an appropriate-for-gestational-age fetus. The mother did not have any clinical signs of infection. Overwhelming bacterial invasion in multiple fetal organs, including the heart, liver, spleen, and kidneys, was observed despite the lack of evidence of maternal clinical infection. The bacteria were visualized by using standard histologic techniques (e.g. H&E/ tissue Gram stain) highlighting the value of autopsy in determining the cause of death.
Topics: Pregnancy; Female; Humans; Stillbirth; Chorioamnionitis; Fetal Death; Fetus; Gestational Age; Sepsis; Placenta
PubMed: 35647781
DOI: 10.1080/14767058.2022.2079404 -
Ultrasound in Obstetrics & Gynecology :... Dec 2022
Topics: Pregnancy; Female; Humans; COVID-19; Placenta; Fetal Death; Parity; Pregnancy Complications, Infectious
PubMed: 35809244
DOI: 10.1002/uog.26029 -
The Journal of Obstetrics and... Jul 2022Although various perinatal outcomes in coronavirus disease 2019 (COVID-19) pregnancies have been reported, the fetal and neonatal consequences of severe acute...
Although various perinatal outcomes in coronavirus disease 2019 (COVID-19) pregnancies have been reported, the fetal and neonatal consequences of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection remain unclear. Several reports of miscarriages and stillbirths have been recorded, but vertical transmission by SARS-CoV-2 is considered very rare, and the cause remains unknown. We report a case of a 22-year-old uncomplicated Japanese woman infected with SARS-CoV-2 during the second trimester, resulting in intrauterine fetal death due to placental insufficiency associated with COVID-19 placentitis. This report emphasizes the importance of longitudinal assessment of fetal well-being by fetal heart rate monitoring and early detection of maternal coagulation dysfunction representing SARS-CoV-2 inflammation to manage COVID-19 in pregnancy.
Topics: Adult; Blood Coagulation Disorders; COVID-19; Chorioamnionitis; Female; Fetal Death; Heart Rate, Fetal; Humans; Infant, Newborn; Infectious Disease Transmission, Vertical; Placenta; Pregnancy; Pregnancy Complications, Infectious; Pregnancy Outcome; SARS-CoV-2; Stillbirth; Young Adult
PubMed: 35605975
DOI: 10.1111/jog.15302 -
Scientific Reports Jul 2022Late-term fetal demise including fetal death in utero, late miscarriage and late termination of pregnancy are relatively frequent occurrences. Post-traumatic stress...
Late-term fetal demise including fetal death in utero, late miscarriage and late termination of pregnancy are relatively frequent occurrences. Post-traumatic stress disorder (PTSD) is a pathology that finds its roots in exposure to a life-threatening event or an event related to death. Exposure to fetal death during a late-term fetal demise is, therefore, a situation at risk of trauma. The objective of this study was to assess the prevalence of PTSD symptoms in the short term among patients faced with late fetal demise, and to identify potential risk factors. All women were assessed at 15 days, one month, and three months after late fetal demise using the Impact of Event Scale-Revised (IES-R) and the Peritraumatic Dissociative Experiences Questionnaire (PDEQ). At 15 days, 44.2% of patients presented a pathological score on the IES-R (≥ 33). At one month and three months, this figure was 34.1% and 9.1% respectively. Factor associated with PTSD symptoms were: peritraumatic dissociation (p = 0.014), seeing the fetus during hospitalization (p = 0.035), holding the fetus in one's arms (p = 0.046), and the organization of a funeral service (p = 0.025). Patients experiencing late fetal demise are at significant risk of trauma. Care providers should remain vigilant to identify high-risk situations to offer appropriate care.Clinical trials registration number: NCT03433989.
Topics: Dissociative Disorders; Female; Fetal Death; Humans; Risk Factors; Stress Disorders, Post-Traumatic; Surveys and Questionnaires
PubMed: 35859001
DOI: 10.1038/s41598-022-16683-5 -
Ultrasound in Obstetrics & Gynecology :... Nov 2016There have been several attempts to classify cause of death (CoD) in stillbirth; however, all such systems are subjective, allowing for observer bias and making...
OBJECTIVES
There have been several attempts to classify cause of death (CoD) in stillbirth; however, all such systems are subjective, allowing for observer bias and making comparisons between systems challenging. This study aimed to examine factors relating to determination of CoD using a large dataset from two specialist centers in which observer bias had been reduced by classifying findings objectively and assigning CoD based on predetermined criteria.
METHODS
Detailed autopsy reports from intrauterine deaths in the second and third trimesters during 2005-2013 were reviewed and findings entered into a specially designed database, in which CoD was assigned using predefined objective criteria. Data regarding CoD categories and factors affecting determination of CoD were examined.
RESULTS
There were 1064 intrauterine deaths, including 246 early intrauterine fetal deaths (IUFD) (< 20 weeks), 179 late IUFDs (20-23 weeks) and 639 stillbirths (≥ 24 weeks' gestation). Overall, around 40% (n = 412) had a clear CoD identified, whilst around 60% (n = 652) were classified as 'unexplained', including around half with identified risk factors or lesions of uncertain significance, with the remaining half (n = 292 (45%)) being entirely unexplained. A stepwise increase in the proportion of unexplained deaths was observed with increasing maceration. Black and Asian women had significantly greater proportions of deaths due to ascending infection, whilst women aged over 40 years had significantly increased placenta-related CoDs. There was no significant difference in CoD distribution according to maternal body mass index or with increasing postmortem interval. Around half of those with an identifiable CoD could be identified from clinical review and external fetal examination or imaging, with most of the remainder being determined following placental examination.
CONCLUSIONS
Based on objective criteria, many intrauterine deaths throughout gestation remain unexplained despite autopsy examination. The rate of unexplained death varies from around 30% to 60% depending on interpretation of the significance of features. CoD determination is dependent on both the classification system used and subjective interpretation, such that variation in the proportion of 'unexplained' cases is based largely on speculation regarding mechanisms of death. Novel methods to determine objectively the mechanism of death at postmortem examination are required. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
Topics: Adult; Autopsy; Cause of Death; Counseling; Female; Fetal Death; Fetus; Gestational Age; Humans; Parents; Placenta Diseases; Pregnancy; Stillbirth
PubMed: 27781317
DOI: 10.1002/uog.16016 -
Acta Obstetricia Et Gynecologica... Nov 2011To examine the pattern and prospective risk of intrauterine fetal death (IUFD) in twin pregnancy by chorionicity.
OBJECTIVE
To examine the pattern and prospective risk of intrauterine fetal death (IUFD) in twin pregnancy by chorionicity.
DESIGN
Retrospective cohort analysis.
SETTING
Large national tertiary referral center.
POPULATION
All consecutive twin deliveries (1997-2006) ≥24 weeks.
METHODS
Retrospective review of all consecutive twin deliveries over 10 years to identify patterns of IUFD in twins and calculate gestation-specific prospective risks of IUFD. Fetal death was defined as intrauterine demise of a fetus ≥24weeks, intertwin birthweight discordance as ≥20% difference and growth restriction as birthweight <5(th) centile. Chorionicity was confirmed by postnatal placental examination.
MAIN OUTCOME MEASURES
Fetal death.
RESULTS
1094 twin pairs including 276 monochorionic-diamniotic (MCDA) (25.3%) and 818 dichorionic-diamniotic (DCDA) twin pregnancies (74.7%) were studied. Twenty-nine fetal deaths occurred affecting 22 twin pregnancies. The incidence of IUFD (death of one or both fetuses) in MCDA twin pregnancies was three times that in DCDA pregnancies [11/276 (3.9)% vs. 11/818 (1.3%) p<0.001]. The majority of deaths in MCDA twins were associated with twin-twin transfusion syndrome (TTTS) prior to 30 weeks. In normally grown twins the prospective risk of IUFD was similarly low in MCDA and DCDA pregnancies after 34 weeks but in pregnancies complicated by abnormal growth, the prospective risk of IUFD was 3.4 in MCDA and 2.0 in DCDA pregnancies.
CONCLUSION
Twin pregnancies complicated by growth restriction or growth discordance were associated with a high risk of IUFD, particularly in affected MCDA twins. Conversely, in normally grown twins the risk was similarly low in MCDA and DCDA pregnancies after 34 weeks.
Topics: Cohort Studies; Female; Fetal Death; Fetal Growth Retardation; Fetofetal Transfusion; Humans; Placenta; Pregnancy; Pregnancy Outcome; Retrospective Studies; Risk; Risk Factors; Twins; Ultrasonography, Prenatal
PubMed: 21762113
DOI: 10.1111/j.1600-0412.2011.01239.x -
Seminars in Fetal & Neonatal Medicine Aug 2009Infection may cause stillbirth by several mechanisms, including direct infection, placental damage, and severe maternal illness. Various organisms have been associated... (Review)
Review
Infection may cause stillbirth by several mechanisms, including direct infection, placental damage, and severe maternal illness. Various organisms have been associated with stillbirth, including many bacteria, viruses, and protozoa. In developed countries, between 10% and 25% of stillbirths may be caused by an infection, whereas in developing countries, which have much higher stillbirth rates, the contribution of infection is much greater. In developed countries, ascending bacterial infection, both before and after membrane rupture, with organisms such as Escherichia coli, group B streptococci, and Ureaplasma urealyticum is usually the most common infectious cause of stillbirth. However, in areas where syphilis is prevalent, up to half of all stillbirths may be caused by this infection alone. Malaria may be an important cause of stillbirth in women infected for the first time in pregnancy. The two most important viral causes of stillbirth are parvovirus and Coxsackie virus, although a number of other viral infections appear to be causal. Toxoplasma gondii, Listeria monocytogenes, and the organisms that cause leptospirosis, Q fever, and Lyme disease have all been implicated as etiologic for stillbirth. In certain developing countries, the stillbirth rate is high and the infection-related component so great that achieving a substantial reduction in stillbirth should be possible by reducing maternal infections. However, because infection-related stillbirth is uncommon in developed countries, and because those that do occur are caused by a wide variety of organisms, reducing this etiologic component of stillbirth much further will be difficult.
Topics: Female; Fetal Death; Humans; Infant, Newborn; Infections; Pregnancy; Pregnancy Complications, Infectious; Pregnancy Complications, Parasitic; Stillbirth
PubMed: 19285457
DOI: 10.1016/j.siny.2009.02.003 -
Folia Neuropathologica 2017. (Review)
Review
.
Topics: Autopsy; Cause of Death; Fetal Death; Humans; Neuropathology; Stillbirth
PubMed: 28677366
DOI: 10.5114/fn.2017.68576 -
Reproductive Biology and Endocrinology... Nov 2003Pregnancy is hypercoagulable state. The field of thrombophilia; the tendency to thrombosis, has been developed rapidly and has been linked to many aspects of pregnancy.... (Review)
Review
Pregnancy is hypercoagulable state. The field of thrombophilia; the tendency to thrombosis, has been developed rapidly and has been linked to many aspects of pregnancy. It is recently that severe pregnancy complications such as severe preeclampsia intrauterine growth retardation abruptio placentae and stillbirth has been shown to be associated with thrombophilia. Recurrent miscarriage and has also been associated with thrombophilia. Finally, thromboembolism in pregnancy as in the non-pregnant state is linked to thrombophilia. In this review all aspects of thrombophilia in pregnancy are discussed, and also all prophylactic and therapeutic implications.
Topics: Antiphospholipid Syndrome; Female; Fetal Death; Humans; Pre-Eclampsia; Pregnancy; Pregnancy Complications, Hematologic; Thrombophilia; Thrombosis
PubMed: 14617365
DOI: 10.1186/1477-7827-1-111 -
Medicine Nov 2019The umbilical cord is the way to exchange gas, supply nutrients, excrete metabolized. Thrombosis of the umbilical cord leads to fetal hypoxia, which jeopardizes fetal...
RATIONALE
The umbilical cord is the way to exchange gas, supply nutrients, excrete metabolized. Thrombosis of the umbilical cord leads to fetal hypoxia, which jeopardizes fetal health and can cause fetal death. Umbilical vessel thrombosis, which is rarely reported, is difficult to detect prenatally.
PATIENT CONCERNS
Both pregnant women had an unremarkable pregnancy course until a routine ultrasound scan in the third trimester showed a single umbilical artery. However, one umbilical vein and 2 umbilical arteries were seen during an ultrasound examination at 32 weeks. Case 2 had a better pregnancy outcome because of the timely discovery of this complication.
DIAGNOSIS
Both cases were diagnosed as umbilical artery thrombosis.
INTERVENTIONS
The first patient received no interventions until they reported decreased fetal movements and gradually disappear. The second patient underwent an emergency cesarean section.
OUTCOMES
In Case 1, an emergency ultrasound examination showed intrauterine fetal death, and the patient vaginally delivered a stillborn child weighing 3300 g in a day. In Case 2, a female neonate weighing 2860 g was delivered by cesarean section, and exhibited Apgar scores of 10 and 10 at 1 and 5 minutes.
CONCLUSION
In the late-term abortions, obstetricians should be vigilant if ultrasound imaging shows suspected umbilical vascular thrombosis or shows 1 umbilical artery when there had previously been 2. The fetus should be closely monitored and interventions implemented as early as possible to improve the prenatal detection rate of umbilical vessel thrombosis and avoid adverse pregnancy outcomes.
Topics: Adult; Cesarean Section; Early Medical Intervention; Emergency Medical Services; Female; Fetal Death; Fetal Monitoring; Humans; Infant, Newborn; Pregnancy; Pregnancy Complications, Cardiovascular; Pregnancy Outcome; Stillbirth; Thrombosis; Ultrasonography, Prenatal; Umbilical Arteries
PubMed: 31770267
DOI: 10.1097/MD.0000000000018170