Importance of fetal autopsy and pathological examination of the placenta in the evaluation of perinatal death

Importancia de la autopsia y del estudio de la placenta en la evaluación de la muerte fetal en el Hospital Universitario de Santander

Objective: to determine the causes of fetal death through maternal medical records review, analysis of the fetal autopsy findings and pathological examination of the placenta. Materials and Methods: a retrospective study of 322 fetal deaths was made during the period of 2005-2009 occurred in the Hospital Universitario de Santander (HUS), Bucaramanga, Colombia. Histopathological analysis of the fetus and placenta were included. The following classification was proposed in regards to the causes of fetal death: 1. Intrisec fetal hypoxia 2. Congenital abnormalities 3. Ascending Infections 4. Trauma during birth 5. Fetal hydrops. Macerated fetuses were considered not classified. The establishment of Subgroups analyzing population such as maternal age, gestational age. Results: a mean maternal age was   25,9 years and mean gestational age: 28,9 weeks. The most frequent causes of death found where intrinsic fetal hypoxia 46.67%, placental insufficiency 17,5%, abruptio 6.6%, placental infarction 6,3%, Maternal Hypertension 4,5%, congenital abnormalities 18,07%, ascending bacterial infection 16,26%, unknown cause 12,04%. In pregnancies between 20-29 weeks the main cause of death was the placental disease and in 37-42 weeks was congenital anomalies (5.1%). Data were analyzed using percentages and averages. Conclusion: the present study shows that the main causes of stillbirth are linked to pathologies that can be detected and properly handled, and exposes the importance of the fetal autopsy added to the anatomical pathology study of the placenta when determining these causes.