Neuropathologic Documentation of Prenatal Brain Damage

Ellis, William G.; Goetzmann, B. W.; Lindenberg, Jeffrey A.

doi:10.1097/00132582-198901000-00006

Cited by 9 publications

(10 citation statements)

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“…In summary, in cases of a markedly fixed FHR without decelerations the diagnosis of intrauterine brain death should be considered after exclusion of the following causes: prolonged fetal behavioural state 1 F (Nijhuis, I986), anencephaly (de H a a n et al., 1971), fetal tachyarrhythmia exceeding the 'logic' of the fetal monitor (Towers and Garite, 1990), developmental abnormalities such as the Dandy-Walker malformation (Ashwal, 1989), and the usage of drugs and hypoxia (Nijhuis et al, 1990). Hydramnios was recently reported as being associated with prenatal brain damage (Ellis et al, 1988), and was detected in both of our cases. When the above situations are excluded and the FHR remains fixed even after vibroacoustic stimulation and/or contraction stress tests, the diagnosis of intrauterine brain death is most likely.…”

Section: Discussionsupporting

confidence: 66%

Cardiotocographic and sonographic findings in two cases of antenatally diagnosed intrauterine fetal brain death

Zimmer¹,

Jakobi²,

Goldstein³

et al. 1992

Prenatal Diagnosis

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Intrauterine fetal brain death is a rare cause of a fixed fetal heart rate pattern. Seven cases have been previously reported in the literature, but only two of them were diagnosed prenatally and all the newborns died soon after delivery. Two additional cases of antepartum diagnosis of intrauterine fetal brain death, managed expectantly, are reported. We had the unique opportunity to document progressive sonographic cerebral changes during the follow-up period, following the neurological event, while the fetus continued life and growth in utero. The cardiographic and sonographic findings suggesting intrauterine fetal brain death were a prolonged fixed fetal heart rate, even following a vibroacoustic and contraction stress test; an atonic fetus without breathing and body movement; and the appearance of hydramnios and the development of ventriculomegaly.

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Section: Discussionsupporting

confidence: 66%

Cardiotocographic and sonographic findings in two cases of antenatally diagnosed intrauterine fetal brain death

Zimmer¹,

Jakobi²,

Goldstein³

et al. 1992

Prenatal Diagnosis

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“…Prenatal diagnosis of brain damage using ultrasonography and magnetic resonance imaging has been widely reported [27][28][29][30] and is corroborated by small pathological studies of perinatal deaths. 13,31,32 Over one-third of our cohort showed evidence of established hypoxic changes, suggesting damage of at least 1-or 2-day duration. In addition, some of the white matter changes suggested damage of longer duration sustained several days before demise.…”

Section: Neuropathologymentioning

confidence: 87%

The Scottish Perinatal Neuropathology Study—clinicopathological correlation in stillbirths

Becher

Bell

et al. 2006

BJOG

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Objective To examine the neuropathology of fetuses dying before birth, to determine the timing of any brain damage seen and to ascertain clinical associations of pre-existing brain damage.Design Population-based observational study.Setting All 22 delivery units within Scotland, 1995Scotland, -1998 Sample All stillborn fetuses ‡24 weeks of gestation excluding those with chromosomal abnormality or central nervous system/cardiothoracic malformation.Methods Clinical detail was collected on all stillborn fetuses. Requests for postmortem included separate request for detailed neuropathological examination. Stillborn fetuses were classified as full term antepartum (normal growth/growth restricted), preterm antepartum (normal growth/growth restricted), intrapartum (full term/preterm), multiple births and stillborn fetuses following abruptions. Clinicopathological correlation attempted to define the timing of brain insult. Placentas were examined for each case where available.Main outcome measures Presence of established and/or recent brain damage.Results Clinical details were available for 471 stillborn fetuses, and detailed neuropathology was possible in 191 cases. Of these 191, 13 were multiple births, 9 died following abruption, 12 were intrapartum deaths and 157 were antepartum stillborn fetuses (99 preterm and 58 full term). Recent or established brain damage was seen in 66% of the entire cohort. Thirty-five percent of all cases showed well-established hypoxic damage predating the last evidence of fetal life, and this was more common in preterm fetuses (P = 0.015), those fetuses with evidence of recent damage (P < 0.001), in pregnancies complicated by pregnancy-induced hypertension (P = 0.044) and those in whom the placenta was <10th centile (P = 0.002).Conclusions Brain damage is commonly seen in stillborn infants, and in around one-third of cases, damage predates the period immediately before death. Factors suggesting suboptimal placental function are associated with such damage. Early identification of placental impairment may lead to improved pregnancy outcome.

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“…While here we have focused on the stratification of histological abnormalities by their immediate relevance to cause of death, in some scenarios, combinations of non-fatal histological abnormalities may imply a mode of death. Examples include increased fat deposition within fetal adrenal glands and various degrees of thymic involution, which may be associated with fetal physiological 'stress' 15 -17 , meconium staining of placental membranes and fetal skin associated with fetal distress in preterm gestations 18,19 , and eosinophilic neurones in association with prenatal hypoxia 20,21 . However, the significance of these findings for future patient management in cases of intrauterine death remains undetermined.…”

Section: Discussionmentioning

confidence: 99%

Stillbirth and intrauterine fetal death: role of routine histological organ sampling to determine cause of death

Man

Hutchinson

Ashworth

et al. 2016

Ultrasound in Obstet & Gyne

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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.

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Neuropathologic Documentation of Prenatal Brain Damage

Cited by 9 publications

References 0 publications

Cardiotocographic and sonographic findings in two cases of antenatally diagnosed intrauterine fetal brain death

Cardiotocographic and sonographic findings in two cases of antenatally diagnosed intrauterine fetal brain death

The Scottish Perinatal Neuropathology Study—clinicopathological correlation in stillbirths

Stillbirth and intrauterine fetal death: role of routine histological organ sampling to determine cause of death

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