Value of fetal skeletal radiographs in the diagnosis of fetal death

Abstract

The aim of this study was to assess the value of fetal skeletal radiographs in determining the etiology of fetal death. A total of 1193 post-mortem fetal skeletal radiographs were analysed. Fetuses were classified into one of three groups (group I: abnormality diagnosed during pregnancy; group II: maternal pathology; group III: spontaneous abortion of pregnancy, IIIa before 26 weeks of gestation (WG), IIIb after 26 weeks of gestation). Face, supine and lateral skeletal views were performed. Skeletal abnormalities were detected in 33.9% of the fetuses, including 22.7% with minor abnormalities (abnormal rib number, no nasal bone ossification, amesophalangia or P2 hypoplasia of the fifth digit) and 14.5% with major abnormalities (other skeletal abnormalities). Among the fetuses with major abnormalities, 98.8% came from group I, 2.9% came from group II, 2.3% came from group IIIa and none came from group IIIb. Fetal skeletal radiographs are not useful in fetuses arising from spontaneous abortion of pregnancy without abnormality on ultrasound screening, abnormality clinical examination or in fetuses with prenatal diagnosis of chromosomal abnormality. This practice is valuable only if there is a multidisciplinary team, with all the participants (pathologists, radiologists, geneticists) knowledgeable about fetal pathology. In the absence of this multidisciplinary approach, it is easier to X-ray all fetuses to avoid misdiagnosis and the important consequences for genetic counselling.

Interventions, outcomes and outcome measurement instruments in stillbirth care research: A systematic review to inform the development of a core outcome set

“…A total of 1492 studies were included for full text review. Of these, 240 studies met the inclusion criteria, representing approximately 298 762 participants …”

Indications, advantages and limitations of perinatal postmortem imaging in clinical practice

“…This has been shown by studies in the 1970s and 1980s in which routine postmortem radiography was diagnostic in about 15% and of no value in >50% [ 11 – 13 ]. A more recent study suggested that postmortem radiography was not useful in the absence of an antenatal sonographic abnormality, abnormal clinical examination or abnormal chromosomal abnormality, although the authors did not address the utility of bone biometry for foetal growth assessment [ 14 ].…”

Comparison of postmortem whole‐body contrast‐enhanced microfocus computed tomography and high‐field magnetic resonance imaging of human fetuses

“…However, parental acceptance of fetal autopsy has decreased over time, mainly due to the invasiveness of the procedure 3,4 . In recent years, non-invasive alternatives have been suggested, including postmortem magnetic resonance imaging (MRI) [5][6][7] , radiography and computed tomography (CT) 8,9 . These alternatives are preferred increasingly by parents, since they do not harm the integrity of the body 4 .…”