The placenta in intrauterine demise

Boyd, Theonia K.

doi:10.1111/apm.12832

Cited by 19 publications

(15 citation statements)

References 6 publications

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“…On occasions the forensic pathologist is asked to determine the timing of a fetal death in cases of home delivery of a stillborn versus a neonaticide, or allegations of medical negligence. Stillbirth results in involutional changes in the placenta that are well described [ 35 ] and recently well summarized by Boyd [ 77 ].…”

Section: Timing Of Placental Pathologymentioning

confidence: 99%

A practical guide to placental examination for forensic pathologists

Mittal

Byard

Dahlstrom

2019

Forensic Sci Med Pathol

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The placenta is a complex interface organ that may hold clues to the reasons for fetal, neonatal or maternal demise. For this reason, placental examination should be a mandatory part of all perinatal or maternal autopsies. While published protocols for the examination of the placenta exist, they are often not adopted. The following review provides practical guidelines for placental examination, with discussion of specific medical conditions that can negatively impact upon the fetus, neonate or mother involving placental pathology to cause death. The review aims to discuss concepts, with illustrations, that forensic pathologists may not routinely focus on in death investigations that may either contribute or mask the cause of a fetal or neonatal death, or are associated with a recurrence risk. While it is recognized that many forensic facilities do not have formal guidelines for placental examination, involvement of local perinatal pathology services in cases is one way of obtaining additional specialist expertise.

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Section: Timing Of Placental Pathologymentioning

confidence: 99%

A practical guide to placental examination for forensic pathologists

Mittal

Byard

Dahlstrom

2019

Forensic Sci Med Pathol

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“…Boyd recently described the placenta's histopathological changes at the intrauterine demise of a fetus. 21 After fetal demise, maternal perfusion and fetal blood pressure to the placenta became undetectable, which led to compromised integrity of the villous capillaries and endothelial karyorrhexis, eventually resulting in fibrosis of the avascular villi and the deposition of solid fibrin in the intervillous spaces. Villous edema and intravillous hemorrhage accompanied by maternal inflammation were also seen to occur with a resulting increase in the placenta's autolytic changes.…”

Section: Discussionmentioning

confidence: 99%

Temporal persistence of residual fetal cell‐free DNA from a deceased cotwin after selective fetal reduction in dichorionic diamniotic twin pregnancies

Chen

Wang

et al. 2021

Prenatal Diagnosis

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Objectives: To determine the temporal persistence of the residual cell-free DNA (cfDNA) of the deceased cotwin in maternal circulation after selective fetal reduction and evaluate its long persistence in noninvasive prenatal testing (NIPT).Methods: Dichorionic diamniotic twins (N ¼ 5) undergoing selective fetal reduction because of a trisomy were recruited. After informed consent, maternal blood was collected immediately before reduction and periodically after reduction until birth.The plasma cfDNA of each sample was sequenced and analyzed for fetal aneuploidy and fetal fractions.Results: In all pregnancies, the fetal fraction of the cfDNA of the deceased fetus increased to peak at 7-9 weeks after fetal reduction, and subsequently decreased gradually to almost undetectable during the late third trimester. The NIPT T-scores persistently reflected the detection of fetal trisomy up to 16 (median 9.5) weeks after fetal reduction. Conclusions:Residual cfDNA from the deceased cotwin after selective reduction at 14-17 gestational weeks led to the persistent generation of false-positive NIPT results for up to 16 weeks postdemise. Thus, providing NIPT for pregnancies with a cotwin demise in early second trimester is prone to misleading results and not recommended. Key PointsWhat's already known about this topic? � The estimated prevalence of a cotwin's fetal demise in all twin pregnancies is 6.2%, although the prevalence might be underestimated. The deceased fetus releases residual cell-free DNA (cfDNA) to the maternal circulation, leading to false-positive findings of fetal aneuploidy on noninvasive prenatal testing (NIPT). However, the evidence is still needed to determine the implications of longitudinal residual cfDNA for NIPT use.This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

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“…Recently, Boyd described the histopathological changes of the placenta in intrauterine demise [27]. After fetal demise, maternal perfusion and fetal blood flow pressure disappear, which leads to the compromise of villous capillary integrity and endothelial karyorrhexis, eventually resulting in fibrosis avascular villi and solid fabrin deposition of intervillous space.…”

Section: Interpretationsmentioning

confidence: 99%

“…After fetal demise, maternal perfusion and fetal blood flow pressure disappear, which leads to the compromise of villous capillary integrity and endothelial karyorrhexis, eventually resulting in fibrosis avascular villi and solid fabrin deposition of intervillous space. Meanwhile, villous edema and intravillous hemorrhage accompanied by maternal inflammation could also occur to increase organ autolysis [27]. It was believed that intravascular karyorrhexis and multifocal villous obliteration might occur soon after fetal demise, whereas extensive obliteration of stem villi and have the level of villous fibrosis may take 14 days or more [27,28].…”

Section: Interpretationsmentioning

confidence: 99%

“…Meanwhile, villous edema and intravillous hemorrhage accompanied by maternal inflammation could also occur to increase organ autolysis [27]. It was believed that intravascular karyorrhexis and multifocal villous obliteration might occur soon after fetal demise, whereas extensive obliteration of stem villi and have the level of villous fibrosis may take 14 days or more [27,28]. Thus, we speculated that the initial discordant change patterns of residual cfDNA released from demised co-twin reflects the complicity of placental autolysis immediately after the cease of fetal blood flow and maternal perfusion.…”

Section: Interpretationsmentioning

confidence: 99%

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Temporal persistence and long-term effect on noninvasive prenatal testing by residual fetal cell-free DNA of demised co-twin after selective fetal reduction in dichorionic diamniotic twin pregnancies

Chen¹,

Su²,

Jia³

et al.

Authorea

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Objectives: To determine the temporal persistence of residual cell-free DNA (cfDNA) of deceased co-twin in maternal circulation after selective fetal reduction and evaluate its long-lasting effect on noninvasive prenatal testing (NIPT) results. Design: Prospective observational study Setting: The Third Affiliated Hospital of Guangzhou Medical University Population: Dichorionic diamniotic twins (n=5) underwent selective fetal reduction of a co-twin with trisomy. Methods: With consent, maternal blood was collected immediately before reduction and periodically after reduction until birth. CfDNA of each maternal blood sample was sequenced for NIPT and analyzed for fetal trisomies and fetal fractions. Main Outcome Measured: Detectable T-scores for trisomy identification and three types of fetal fractions including the total fetal fraction, the fetal fraction of the deceased co-twin, and the fetal fraction of the surviving co-twin.

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The placenta in intrauterine demise

Abstract: Placental changes in intrauterine demise can be similar to antemortem pathologic processes. This chapter provides an overview of postmortem placental changes, and provides an algorithmic set of considerations for discriminating between ante- and postmortem pathology.

Cited by 19 publications

References 6 publications

A practical guide to placental examination for forensic pathologists

A practical guide to placental examination for forensic pathologists

Temporal persistence of residual fetal cell‐free DNA from a deceased cotwin after selective fetal reduction in dichorionic diamniotic twin pregnancies

Temporal persistence and long-term effect on noninvasive prenatal testing by residual fetal cell-free DNA of demised co-twin after selective fetal reduction in dichorionic diamniotic twin pregnancies

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