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+A: AbstractObjectives There have been many attempts to classify cause of death in stillbirth, all such systems being subjective, allowing for significant observer bias, making accurate comparisons between systems challenging. The aim of this study was to examine factors relating to determination of cause of death by using a large dataset from two specialist centres, in which observer bias has been reduced by objectively classifying findings and assigning causes of death based on predetermined criteria.Methods Detailed autopsy reports from intrauterine fetal deaths (IUFD) during [2005][2006][2007][2008][2009][2010][2011][2012][2013] in the second and third trimesters were reviewed and findings entered into a specially designed database, in which cause of death (CoD) was assigned using predefined objective criteria. Data regarding CoD categories and factors affecting determination of CoD were analysed through queries and statistical tests run using Microsoft Access, Excel, Graph Pad Prism and StatsDirect, with Mann-Whitney U-test and comparison of proportions testing as appropriate.Results There were 1,064 IUFDs, including 639 stillbirths at >23 weeks' gestation.Overall, around 40% (412 (39%)), had a definite or highly likely cause of death identified, whilst 60% (652) were classified as 'unexplained'. Of these, around half had identified risk factors, or lesions of uncertain significance present, whilst the remaining half (292 (45%)) were entirely unexplained. A stepwise increase in the proportion of unexplained deaths was observed with increasing severity of maceration. Black and Asian women had significantly greater proportions of deaths due to ascending infection whilst women aged over 40 had significantly increased placental-related causes of death. There was no significant difference in cause of death distribution by maternal 3 body mass index or with increasing post-mortem interval. Almost 20% of definitive or likely causes of death could be identified from clinical review or external examination / imaging of the fetus, with most of the remainder being determined following placental examination.Conclusions Based on objective criteria, most IUFDs across gestation remain unexplained despite autopsy examination. The rate of unexplained death varies between 30 and 60% depending on interpretation of the significance of features. The cause of death provided across studies is variable and dependent on both the classification system used and subjective interpretation such that reduction in the proportion of 'unexplained' cases across studies is largely based on speculation around mechanism of death. Novel methods to determine objectively the mechanism of death at postmortem examination are required. 4 +A: IntroductionThe primary aim of postmortem investigation of intrauterine death is determination of cause and mechanism of death, to facilitate counseling of parents, management of subsequent pregnancies and future interventions [1][2][3][4] . Over the last 50 years there have been many attempts to classify cause o...

Chronic granulomatous disease may present to histopathologists in a wide range of tissue specimens most often demonstrating features of active chronic inflammation with or without granuloma formation. The presence of numerous pigmented macrophages in association with such inflammation should raise suspicion of the diagnosis. In addition, diffuse granulomatous inflammation of the lung and hepatic abscess formation should be regarded as suggestive of the diagnosis.

Objective

Objectives Guidelines for the investigation of intrauterine death and sudden unexpected death in infancy (SUDI) recommend, based on expert opinion, autopsy procedures and tissue sampling strategies for histological analysis. Although stillbirth is much more common than SUDI, there have been no large‐scale studies published which evaluate the usefulness of histological evaluation of specific organs in stillbirth for determining cause of death. Our aim was to evaluate the use of macroscopic and microscopic assessment of internal organs to determine cause of intrauterine death. Methods As part of a larger study evaluating several aspects of autopsy findings in intrauterine death, a dedicated database was used to collate antenatal and postmortem examination details for cases of intrauterine death examined between 2005 and 2013 at two tertiary specialist centers in London, UK. Histological findings for all organs were examined in relation to the final cause of death, as determined by objective criteria. Results Among 1064 intrauterine deaths, the majority (> 80%) of cases had internal organs that were normal on both macroscopic and microscopic examination. There was no case in which histological cardiac examination provided the cause of death when the macroscopic appearance of the heart was normal. Microscopic examination of lung tissue revealed 13 (1%) cases with histological abnormalities that provided the cause of death when the macroscopic appearance was normal, but there was only one (0.1%) case in which the diagnosis would not have been apparent on placental examination: a case of congenital cytomegalovirus infection. There was no case in which microscopic examination of macroscopically normal liver, kidneys, adrenals, spleen, thymus, intestines, pancreas, brain or thyroid provided the cause of death. Conclusion In this large series of autopsies in cases of intrauterine death, only around 1% of cases demonstrated histological abnormalities which provided the cause of death when the internal organs appeared normal macroscopically. There was no case in which routine histological examination of most tissues provided diagnostically useful information that was not apparent from other examinations, such as placental pathology. There is little benefit, purely in terms of determining cause of death, in obtaining tissue from most macroscopically normal organs for routine histological examination. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.