Evaluation of 2407 fetuses in a Turkish population

Ceylaner, Giilay; Ceylaner, Serdar; Günyeli, İlker; Ekici, Eyiip; Celasun, Bülent; Danışman, Nuri

doi:10.1002/pd.1762

Cited by 13 publications

(19 citation statements)

References 13 publications

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“…Pathologic evaluation of D&E specimens for midtrimester IUFD has not been studied in the literature to our knowledge. However, there are several recent studies [58][59][60][61][62][63] that have examined the value of pathologic examination of the fetus and placenta for intact fetuses in setting of IUFD, and the American College of Obstetricians and Gynecologists 64 recommends autopsy and placental evaluation be offered for all stillbirths. A study of the Stillbirth Collaborative Research Network 58 involving 663 stillbirths in both the second and third trimesters, and including postmortem examinations in more than 500 patients, showed that 66% of stillbirths have at least 1 positive result among the 3 major components of the evaluation: perinatal autopsy, placental examination, or karyotype.…”

Section: 54mentioning

confidence: 99%

Pathologic Examination of Fetal and Placental Tissue Obtained by Dilation and Evacuation

Ernst

Gawron

Fritsch

2013

Archives of Pathology &Amp; Laboratory Medicine

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Context.-Dilation and evacuation (D&E) is an alternative method to induction of labor for pregnancy termination and intrauterine fetal demise, and it is the most common mode of second-trimester uterine evacuation in the United States. Many D&E specimens are examined in surgical pathology, and there is little information available in surgical pathology textbooks or the literature to assist pathologists in these examinations.Objective.-To provide an overview of the D&E procedure, discuss related legal issues, provide guidelines for routine pathologic examination of D&E specimens, and demonstrate the importance of careful pathologic examination of D&E specimens.Data Sources.-Case-derived material and literature review.Conclusions.-Pathologic examination of D&E specimens has been understudied. However, the available literature and our experience support the fact that careful pathologic examination of D&E specimens can identify significant fetal and placental changes that can confirm clinical diagnoses or provide definitive diagnosis, assist in explaining the cause of intrauterine fetal demise, and identify unexpected anomalies that may provide further clues to a diagnostic syndrome or mechanism of anomaly formation.(Arch Pathol Lab Med. 2013;137:326-337; doi: 10.5858/ arpa.2012-0090-RA) P athologic examination of products of conception in routine surgical pathology practice consists largely of the gross and microscopic examination of fragmented fetal and placental tissue from first-trimester missed or induced abortions. The majority of these pathology specimens are handled grossly by technicians, and for the most part, the main goal is the pathologic documentation of chorionic villi and fetal parts. However, pathologists, especially at large academic medical centers, are encountering an increasing number of disrupted, second-trimester fetal specimens for examination. Prior to the 1970s, uterine evacuation in the second trimester was accomplished via labor induction methods, such as prostaglandin or saline instillation, or by hysterotomy, and resulted in an intact fetus. The development of the dilation and evacuation (D&E) procedure during this time period gave an alternative to these methods. In 1974, only 36% of all midtrimester abortions were managed via D&E, but the safety and popularity of this method increased that number to 96% in 2005. 1 The development of a fellowship in family planning in 1991 has trained a new generation of academic D&E providers. This is a 2-year postgraduate training program for obstetrician-gynecologists and focuses on advanced clinical skills, research, and teaching in the field of contraception and abortion. A total of 179 fellows have graduated, with 79% holding positions in academic centers.2 The addition of a trained fellow to an institution will increase access to D&E services and allow women options for management of an unintended or abnormal pregnancy. Women have been shown to preferentially choose management via D&E over labor induction in the second trimester, avoiding an unpr...

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Section: 54mentioning

confidence: 99%

Pathologic Examination of Fetal and Placental Tissue Obtained by Dilation and Evacuation

Ernst

Gawron

Fritsch

2013

Archives of Pathology &Amp; Laboratory Medicine

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“…Two studies demonstrate the utility of pathologic examination of an intact IUFD specimen after a labor induction. A Turkish study 5 of 2407 intact pregnancy terminations included 759 IUFD specimens between 10-and 24-weeks' gestation. Pathologists documented abnormal findings in 14.3% of specimens (n ¼ 112 of 759) and findings other than congenital anomalies in 9.6% of specimens (n ¼ 73 of 759), although the number identified through autopsy versus surgical examination was not included.…”

Section: Resultsmentioning

confidence: 99%

“…5 Since modern ultrasound technology identifies many morphologic abnormalities, researchers have questioned the added value of a pathologic examination. 6,7 However, most second-trimester patients have not yet undergone a full anatomic ultrasound evaluation at the time of fetal demise.…”

mentioning

confidence: 99%

Perinatal Pathologic Examination of Nonintact, Second-Trimester Fetal Demise Specimens: The Value of Standardization

Gawron

Hammond

Ernst

2013

Archives of Pathology &Amp; Laboratory Medicine

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Context.-Management of second-trimester intrauterine fetal demise via dilation and evacuation results in nonintact specimens for pathologic examination. Surgical pathology examination is often mandated; however, evidence on expected findings and specimen evaluation guidelines are lacking.Objective.-To assess pathologic findings of nonintact, second-trimester fetal demise specimens, through comparison of anatomic abnormalities identified on standardized perinatal examination to individualized general pathology examinations.Design. ], P , .001). Forty-eight abnormalities were identified: 77.0% (n ¼ 37) were placental and 23.0% (n ¼ 11) were fetal. Chromosomal analysis was done on 73.7% (n ¼ 87 of 118) with 12.6% (n ¼ 11 of 87) showing abnormalities. Among aneuploid specimens, the perinatal pathologist confirmed abnormalities in 66.7% (n ¼ 4 of 6) of cases while general pathologists confirmed abnormalities in 0% (n ¼ 0 of 5) (P ¼ .02).Conclusions.-Systematic surgical pathology examination of nonintact, second-trimester fetal demise specimens yields increased information on fetal or placental abnormalities, which may be clinically useful. Institutions with high-risk obstetrical practices and dilation and evacuation providers should consider integrating a standardized perinatal checklist into educational and practice guidelines.

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“…it has been shown through some studies that these can be reduced substantially by means of improved prenatal, obstetric and postnatal care (1).…”

Section: Introductionmentioning

confidence: 99%

“…Therefore, clinicians, geneticists, pediatric surgeons, radiologists and pathologists are required to be consulted for certain diagnosis of anomalies as well as the application of right methods so as to overcome such cases (1). a further issue to be dealt with thoroughly is the implications of anomalies in fetuses for future pregnancies.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of fetal autopsy findings in the hatay region: 274 cases

Hakverdı¹,

Güzelmansur²,

Güngören³

et al. 2012

TJPATH

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Objective: The aim of this study was to present the incidence of fetal anomalies in our region of Hatay, Turkey in order to determine the efficiency of prenatal diagnosis through fetal autopsy, and to compare our statistical data with other national and international studies. Material and Method:This study was conducted on 274 fetuses from terminated pregnancies due to abnormal prenatal findings and intrauterine deaths from 2005 to September 2010. Fetuses were evaluated through postmortem examination, external measurements, X-rays, Magnetic resonance images, Multislice Computerized Tomography and photographs. The autopsy was completed by the histological examination of each organ.Results: autopsy was conducted on 274 fetuses. a fetal anomaly was detected in 160 (58.39%) cases. The central nervous system contained the most frequent structural defects (79 cases, 49.38%), followed by malformations in the musculoskeletal system in 36 cases (22.5%). The most frequent multiple system anomalies were central nervous system defect and bilateral adrenal agenesis, musculoskeletal system malformations and urinary system defects. Fetal autopsy provided additional findings in 43 cases (26.88%). Conclusion:Fetal autopsy is a very important procedure and an integral part of the general prenatal management. new findings through this method may suggest invaluable data for parents about potential risks in future pregnancies.

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Evaluation of 2407 fetuses in a Turkish population

Abstract: Postmortem evaluation is useful to detect findings necessary for genetic counseling. Our protocol is effective especially in fetuses with congenital anomalies but it can detect only some of the fetal reasons in IUFD cases. A more detailed protocol is needed to investigate IUFD cases.

Cited by 13 publications

References 13 publications

Pathologic Examination of Fetal and Placental Tissue Obtained by Dilation and Evacuation

Pathologic Examination of Fetal and Placental Tissue Obtained by Dilation and Evacuation

Perinatal Pathologic Examination of Nonintact, Second-Trimester Fetal Demise Specimens: The Value of Standardization

Evaluation of fetal autopsy findings in the hatay region: 274 cases

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