Placental findings in singleton stillbirths: a case-control study from a tertiary-care center in India

Objectives Placental examination in a case of stillbirth can provide insight into causative/associated factors with fetal demise. The aim of this study was to compare placental and umbilical cord pathologies in singleton stillbirth and livebirth placentas, and to find prevalence of various associated maternal and fetal clinical factors. Methods This case-control study was conducted at a tertiary-care center in India over a period of 20 months. About 250 women who delivered stillborn fetus ≥28 weeks’ gestation and 250 maternal-age-matched controls were recruited. Sociodemographic and clinical details were noted and placental gross and microscopic examination was done. Placental findings were compared between stillbirth and livebirth (overall), preterm stillbirth and preterm livebirth as well as term stillbirth and term livebirth in six categories – placenta gross, cord gross, membranes gross, maternal vascular malperfusion, fetal vascular malperfusion and inflammatory response. Prevalence of 11 maternal and fetal factors were studied in all categories of placental findings in both livebirth and stillbirth. Results Placental findings in all six categories were significantly associated with stillbirths (p<0.05). The placental findings associated with stillbirth with highest odds included placental hypoplasia (OR 9.77, 95% CI 5.46–17.46), necrotizing chorioamnionitis (OR 9.30, 95% CI 1.17–73.96) and avascular villi (OR 8.45, 95% CI 3.53–20.25). More than half of the women with stillbirths had medical disorders (n=130, 52.0%) and the most prevalent was hypertensive disorder (n=45, 18.0%). Conclusions Changes in placenta are associated with development of stillbirth. Therefore, antenatal investigations to identify placental dysfunction should be investigated to determine whether these reduce stillbirth. Also, placental examination in a case of stillbirth can detect/diagnose many maternal/fetal conditions and thereby can help in preventing future stillbirths.

Late Intra-Uterine Fetal Demise with Fetal Hydrops: Challenges of Management Planning in Indonesia

<p>Intra-Uterine Fetal Demise (IUFD) is defined as death of human conception at age of 20 weeks’ gestation or older or with a minimum 500-g birthweight before complete delivery from the mother and induced termination involved. In 2015, Indonesia has contributed a stillbirth rate of 13 out of 1,000 total births in which 17.1% of the cases were caused by congenital anomalies. Fetal Hydrops as a pathological condition in which there is an accumulation of fluid in fetal soft tissues and serous cavities. With the advancements of sonographic technology, identification of fetal hydrops has become uncomplicated. However, what remains a challenge is to investigate etiology and determine management. In order to plan proper management, the etiology of fetal hydrops must first be determined to predict the prognosis of fetal hydrops. In Indonesia; limited facilities and experts combined with high costs in etiology determination and management have complicated the matter. Furthermore, the strong influence of several Eastern communities’ norms and religious views have further complicated both physicians and patients in decision making. In this report, we present a case of late intra-uterine fetal demise with fetal hydrops, whom was admitted on her 35 weeks age gestation. We performed elective Caesarean Section in order to deliver the stillborn fetus, with no significant post-operative complication. Unfortunately, this condition was actually diagnosed earlier during 20^th weeks of gestation, hence advised to continue the pregnancy without further evaluation and information to the mother regarding the hydrops condition.</p>

Congenital dislocation of the knee: a morphological study

Background. Congenital knee dislocation is a rare disease of the musculoskeletal system (1 in 100,000 live births). In the literature, few studies have described the anatomical changes characteristic of this pathology, which are only revealed during surgical treatment. Aim. This study aimed to evaluate the pathomorphological features of the ligamentousarticular apparatus and thigh muscles with congenital knee dislocation on autopsy material. Materials and methods. The study included two fetuses with bilateral congenital knee dislocation after spontaneous miscarriage at 18 and 20 weeks of gestation and one stillborn fetus with bilateral congenital knee dislocation at 29 weeks of gestation. The comparison group was composed of two fetuses after spontaneous miscarriages at 18 and 20 weeks of gestation and one stillborn fetus at 25 weeks of gestation without anomalies of the lower extremities. Results. Various abnormalities and displacements of the anatomical structures, as well as degenerative dystrophic changes in the soft tissues during histological examination, were found. Pathomorphological changes in the control group were not detected. Conclusion. Pathomorphological changes are the main manifestations of congenital knee dislocation in the studied fetuses.

An Unusual Case of Ruptured Uterus Associated With Placenta Abruption: Case Report

Association of abruption of placenta and ruptured uterus is extremely rare, there were only a few cases described in the past. A 24 year-old woman, G2P1 L0 with history of previous Cesarean Section for obstructed labour and now at 7 months of pregnancy, presented with features of acute abdomen with severe anemia. Her pulse rate was 136 per minute, temperature 36.1o C., respirations 28 per minute, blood pressure 96/50 mm. of Hg. Height of uterus 28 weeks, had tenderness and rigidity over the upper abdomen. She was suspected to have Haemoperitoneum due to ruptured uterus, and laparotomy was performed under IV Ketamine as provision of general anaesthesia was unavailable. Intra-operative findings were Haemoperitoneum, recovery of huge amount of clots from peritoneal cavity, Posterior fundal rupture with intact amniotic sac. A fresh stillborn fetus was delivered from the intact amniotic cavity with clear liquor through the rupture site followed by repair of the rent. She received blood transfusion and recovered without any complication. Laparotomy allowed us to discover this unusual presentation in this patient.

Ectopic Liver Within the Placental Parenchyma of a Stillborn Fetus

Rarely, liver tissue can be seen in the umbilical cord, where it is thought to result from ectopic localization during embryogenesis. The placental parenchyma is also a rare site for this occurrence. The exact pathophysiology of ectopic liver in the placenta is unknown. It has been considered that aberrant migration or displacement of cells from the developing hepatic buds leads to ectopic liver formation, including groups of liver cells that become entrapped in the foregut as the diaphragm closes. Additional hypotheses put forward have included monodermal teratoma and hepatocellular adenoma. While the lesions may not actually be adenomas, this term has been most utilized in the literature. Hepatocellular adenomas of the placenta are extremely rare; only 9 cases have been reported thus far. We report an additional occurrence of ectopic liver in the placenta, which is the only one reported in a stillborn, and review the literature.

Complete Genome Sequence of a Highly Pathogenic Porcine Reproductive and Respiratory Syndrome Virus Variant with a New Insertion in Glycoprotein 5, Isolated from a Stillborn Fetus

Here, we report the complete genome sequence of strain GD-2011, a highly pathogenic porcine reproductive and respiratory syndrome virus (HP-PRRSV) that was isolated from a stillborn fetus. The GD-2011 strain is characterized by a discontinuous 30–amino acid deletion in the nonstructural protein 2. In addition, GD-2011 had a 1–amino acid insertion in glycoprotein 5, which does not exist in any other HP-PRRSV strains.