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The '''fetal autopsy''' is done to determine the cause of death in a fetus. | The '''fetal [[autopsy]]''' is done to determine the cause of death in a fetus. An introduction to the autopsy is in the ''[[autopsy]]'' article. | ||
==Routinue sections | ==External exam== | ||
===Post-mortem changes=== | |||
Sequences of changes with intrauterine death:<ref name=Ref_HospAuto191>{{Ref HospAuto|191}}</ref> | |||
*Normal ~0-12 hours. | |||
*Skin blistering - usu. prominent on head ~12-48 hours. | |||
*Moderate skin separation (sloughing) - usu. hands & feet ~48-72 hours | |||
*Massive skin separation and loosing of symphysis menti (midline mandible), symphysis pubis ~72+ hours. | |||
===Common measures<ref name=Ref_HospAuto196>{{Ref HospAuto|196, 198}}</ref>=== | |||
*Body mass (weight). | |||
*Crown-to-heel length. | |||
*Crown-to-rump length. | |||
*Occipito-frontal circumference. | |||
*Chest circumference - at nipples. | |||
*Abdominal circumference - at umbilicus. | |||
==Routinue sections== | |||
# Rib. | # Rib. | ||
# Thymus, skin, diaphragm, psoas muscle. | # [[Thymus]], skin, diaphragm, psoas muscle. | ||
# Rectum, duodenum, ileocecal region, mesentery. | # Rectum, duodenum, ileocecal region, mesentery. | ||
# Adrenal gland. | # Adrenal gland. | ||
# Kidney. | # [[Kidney]]. | ||
# Bladder. | # [[Bladder]]. | ||
# Internal genitalia. | # Internal genitalia. | ||
# Spleen. | # [[Spleen]]. | ||
# Stomach, GE junction, GD junction, pancreas. | # [[Stomach]], GE junction, GD junction, [[pancreas]]. | ||
# Liver. | # [[Liver]]. | ||
# Right lung. | # Right [[lung]]. | ||
# Left lung. | # Left lung. | ||
# Heart. | # [[Heart]]. | ||
# Upper airway with thyroid. | # Upper airway with thyroid. | ||
# Pituitary. | # [[Pituitary]]. | ||
==Adrenal gland== | ==Microscopic== | ||
===Adrenal gland=== | |||
*Centre regresses. | *Centre regresses. | ||
==Kidney== | ====Adrenal fetal fat pattern==== | ||
*Can be assessed with ''oil red O'' staining. | |||
The pattern of adrenal fat is informative about duration of stress prior to (intrauterine) demise:<ref>{{cite journal |author=Becker MJ, Becker AE |title=Fat distribution in the adrenal cortex as an indication of the mode of intrauterine death |journal=Hum. Pathol. |volume=7 |issue=5 |pages=495–504 |year=1976 |month=September |pmid=964978 |doi= |url=}}</ref> | |||
*Pattern I: scant fat/fat only close to medullary zone; acute death/no stress reaction. | |||
*Pattern II: widespread fat; subacute death/moderate stress reaction. | |||
*Pattern III: massive fat - fetal zone and cortex; chronic death/marked stress reaction. | |||
Additional ref.: [http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1545415/pdf/archdisch00800-0007.pdf http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1545415/pdf/archdisch00800-0007.pdf]. | |||
===Kidney=== | |||
*Cortex regresses. | *Cortex regresses. | ||
*Nephrogenic rests.<ref>URL: [http://www.wilmstumour.com/rests.asp http://www.wilmstumour.com/rests.asp]. Accessed on: 28 March 2011.</ref> | |||
==Lung== | ===Lung=== | ||
*PMNs may be seen in [[chorioamnionitis]]. | *PMNs may be seen in [[chorioamnionitis]]. | ||
*Meconium-laden macrophages may be seen. | |||
===Thymus=== | |||
*Hassall's corpuscles (thymic corpuscle). | |||
Image: | |||
*[http://commons.wikimedia.org/wiki/File:Thymic_corpuscle.jpg Thymic corpuscle (WC)]. | |||
==Amniotic rupture sequence== | |||
*[[AKA]] ''amnion rupture sequence''. | |||
===General=== | |||
The term encompasses:<ref>URL: [http://moon.ouhsc.edu/kfung/jty1/neurotest/Q11-Ans.htm http://moon.ouhsc.edu/kfung/jty1/neurotest/Q11-Ans.htm]. Accessed on: 26 October 2010.</ref> | |||
*Amniotic band syndrome.<ref name=pmid2624577>{{Cite journal | last1 = Lin | first1 = HH. | last2 = Wu | first2 = CC. | last3 = Hsieh | first3 = FJ. | last4 = Hsieh | first4 = CY. | last5 = Lee | first5 = TY. | title = Amniotic rupture sequence: report of five cases. | journal = Asia Oceania J Obstet Gynaecol | volume = 15 | issue = 4 | pages = 343-50 | month = Dec | year = 1989 | doi = | PMID = 2624577 }}</ref> | |||
*Amniotic adhesion sequence. | |||
*Limb-body wall complex - characterized by ventral body wall defects.<ref name=pmid18603699>{{Cite journal | last1 = Prasun | first1 = P. | last2 = Behera | first2 = BK. | last3 = Pradhan | first3 = M. | title = Limb body wall complex. | journal = Indian J Pathol Microbiol | volume = 51 | issue = 2 | pages = 255-6 | month = | year = | doi = | PMID = 18603699 }}</ref> | |||
Etiology: | |||
*Congenital. | |||
**Thought to arise due to an amniotic tear in the first trimester.<ref name=pmid19180633>{{Cite journal | last1 = Jamsheer | first1 = A. | last2 = Materna-Kiryluk | first2 = A. | last3 = Badura-Stronka | first3 = M. | last4 = Wiśniewska | first4 = K. | last5 = Wieckowska | first5 = B. | last6 = Mejnartowicz | first6 = J. | last7 = Balcar-Boroń | first7 = A. | last8 = Borszewska-Kornacka | first8 = M. | last9 = Czerwionka-Szaflarska | first9 = M. | title = Comparative study of clinical characteristics of amniotic rupture sequence with and without body wall defect: further evidence for separation. | journal = Birth Defects Res A Clin Mol Teratol | volume = 85 | issue = 3 | pages = 211-5 | month = Mar | year = 2009 | doi = 10.1002/bdra.20555 | PMID = 19180633 }}</ref> | |||
**Karyotypes are usually normal. | |||
===Gross=== | |||
Features: | |||
*Autoamputation of appendages and body wall defects +/- anomalies of internal organs. | |||
*+/-Fibrous bands (seen cases labelled ''amniotic band syndrome''). | |||
Images: | |||
*[http://www.sonoworld.com/fetus/page.aspx?id=2318 Amniotic band syndrome - gross (sonoworld.com)]. | |||
*[http://www.gfmer.ch/genetic_diseases_v2/gendis_detail_list.php?offset=15&cat3=535 Amniotic band syndrome - several images (gfmer.ch)]. | |||
==Developmental stuff== | |||
===Neural tube defects=== | |||
*Anencephaly - no brain, top of head missing. | |||
*Spina bifida. | |||
**Spina bifida cystica. | |||
***Meningocele - less severe, herniation of only the membrane. | |||
***Myelomeningocele - more sever, herniation of membranes and cord. | |||
**Spina bifida occulta. | |||
===Chiari malformation=== | |||
{{Main|Chiari malformation}} | |||
===Dandy-Walker syndrome=== | |||
*[[AKA]] Dandy-Walker malformation (DWM). | |||
*Prevalence: ~ 1/5000 live borns. | |||
*Diagnosis: ultrasound. | |||
Features:<ref>URL: [http://moon.ouhsc.edu/kfung/jty1/neurotest/Q12-Ans.htm http://moon.ouhsc.edu/kfung/jty1/neurotest/Q12-Ans.htm]. Accessed on: 26 October 2010.</ref> | |||
*Complete or partial agenesis of the vermis. | |||
*Cystic dilatation of the fourth ventricle. | |||
*Large posterior fossa. | |||
*+/-Hydrocephalus. | |||
*+/-Elevation of cerebellar tentorium. | |||
DDx: | |||
*Arachnoid cyst. | |||
*Blake's pouch cyst - on a contiunuum with DWM.<ref name=pmid10872175>{{Cite journal | last1 = Calabrò | first1 = F. | last2 = Arcuri | first2 = T. | last3 = Jinkins | first3 = JR. | title = Blake's pouch cyst: an entity within the Dandy-Walker continuum. | journal = Neuroradiology | volume = 42 | issue = 4 | pages = 290-5 | month = Apr | year = 2000 | doi = | PMID = 10872175 }}</ref> | |||
== | ==Growth parameters== | ||
{{Main|Growth charts}} | |||
==See also== | ==See also== | ||
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[[Category:Autopsy]] | [[Category:Autopsy]] | ||
[[Category:Pediatric pathology]] |
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