Man, JA; (2016) Autopsy investigation in stillbirth. Doctoral thesis , UCL (University College London).

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Abstract

The UK has the highest rate of stillbirth in the developed world and there are more than three million stillbirths worldwide each year. With over 30 different classification systems, the rate of unexplained stillbirth varies from 15-60% despite postmortem investigation being undertaken in a number of cases. The primary aims of this project were to use a unique autopsy database to examine a large well characterised series of stillbirth autopsies to assess specific causes of death, relationships between fetal maceration, intrauterine and postmortem interval on cause of death and fetal intrauterine growth restriction as well as producing evidence based guidelines for autopsy practise and investigating the potential role of novel techniques in future stillbirth autopsy. The analysis of more than 1000 intrauterine and intrapartum fetal deaths revealed that two thirds had an unexplained cause of death. Internal examination of the fetuses provided a definitive cause of death in 1% of cases; 19% of the overall causes of death could have been diagnosed from review of the clinical circumstances and a further 18% by placental macroscopic and microscopic examination. Significant associations were found between increasing maceration and Small for Gestational Age (SGA) fetuses and that using birthweight or bodyweight alone erroneously overestimate the role of SGA as an underlying factor in stillbirth causation. Other investigations such as modified organ weight ratios may contribute to determining cause of death. Proteomic experiments proved that in principle significantly different amounts and types proteins could be successfully extracted from formalin fixed paraffin embedded stillbirth fetal tissue in different case groups, suggesting a possible future investigation into the causation of stillbirth.

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