Supervisors info:
Δημήτριος Κασσάνος, Ομότιμος Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Σοφία Καλανταρίδου, Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Εμμανουήλ Ζουμάκης, Επίκουρος Καθηγητής, Ιατρική Σχολή ΕΚΠΑ
Summary:
Fetal Death, or Intrauterine Death, is defined as the death prior to complete expulsion or extraction from the mother of a product of human conception, irrespective of the duration of pregnancy. It is not an induced termination of gestation, and it concerns the delivery of a fetus showing no signs of life as indicated by the absence of breathing, heartbeats, pulsation of the umbilical cord, or definite movements of voluntary muscles.
The aim of this thesis is the conduction of a narrative review of the current literature by searching 3 of the most eminent medical databases (Medline-Pubmed, Cochrane Library, and Science Direct) using a combination of free-text terms and MeSH (Medical Subject Headings) terms. This will allow the reader to understand more thoroughly the different aspects of intrauterine death.
First, the necessary definitions are presented; terms such as fetal death, intrauterine death, stillbirth, antepartum and intrapartum death are clearly defined, and their differences are stated. These definitions vary among different countries. Besides, epidemiological data of both developed and underdeveloped areas of the planet are demonstrated, while specific numbers are given for the USA, European countries, and Greece.
Next, the author moves to an analysis of the risk factors correlated with fetal death, which are divided into three categories: the environmental ones, the maternal ones, and those associated with the current gestation. Nevertheless, a correlation does not necessarily prove the existence of a “cause – effect” relationship.
Signs of fetal hypoxia are the main features recognized in the majority of intrauterine deaths, and they are primarily associated with placental lesions. The most prominent histopathological lesions, met in fetal death, are the acute inflammatory lesions, the chronic inflammatory lesions, the maternal vascular malperfusion, as well as the fetal vascular malperfusion.
There is an essential number of intrauterine causes of death classification systems, such as the CODAC (Causes of Death and Associated Conditions) and ReCoDe (Relevant Condition at Death) systems. Most importantly, the majority of fetal deaths lie on a placental cause, and umbilical cord’s anomalies, infections, chromosomal and congenital anomalies, maternal complications, and fetal complications follow.
Information and details regarding the examination of the dead fetus, consisting of the autopsy, the genetic testing, and pathology investigation, are provided. The couple, and especially the mother, need to be equally examined and evaluated. Finally, the strategy concerning the management of a subsequent gestation (in a woman with history of stillbirth) is likewise analyzed.
Keywords:
Intrauterine death, Fetal death, Stillbirth, Fetal loss, Fetal demise, Intrauterine fetal demise
