An autopsy based descriptive study of the spectrum of pulmonary lesions encountered in fetal deaths at a tertiary care center

Background: Fetal autopsy has been an indispensable tool in evaluating the cause of death. The most common cause for fetal deaths is associated with respiratory disorders accounting for around 60%. This study was undertaken to evaluate the gross and microscopic features of lungs in fetal autopsies and estimate the incidence of deaths attributable to pulmonary causes. Materials and Methods: All fetuses received for autopsy at our institute were included in the study with prior consent. Gross and microscopic findings along with relevant clinical data were recorded. Results: A total of 426 autopsies were conducted from January 2011 to August 2016. Of those, 184 had abnormal pulmonary findings constituting 43.19%. Aspiration pneumonia was the most common finding with 67 cases (36.4%), followed by atelectasis 54 cases (29.3%), congenital cystic adenomatoid malformation in 13 cases (7.1%), lung hypoplasia 12 cases (6.5%), pulmonary hemorrhage 21 (11.4%), 15 cases (8.15%) of hyaline membrane disease, one case (0.5%) of heterotaxy, and one case of extralobar pulmonary sequestration (0.5%). Congenital malformations of lungs were seen in 27 (14.67%) cases and 38 cases (20.65%) had other associated anomalies. Conclusion: Pulmonary pathology is the most common finding in fetal deaths with aspiration pneumonitis being the most common avoidable cause. Accurate fetal autopsy along with clinical data are important in evaluating fetal deaths and can help in reduction of unexplained stillbirths.

Significance of fibrotic bands in utero ‑ Amniotic band sequence with limb body wall complex: A rare case of fetal autopsy.

Amniotic band sequence (ABS) includes a wide spectrum of abnormalities resulting from entrapment of various fetal parts from a disrupted amnion, ranging from a mere constriction ring affecting a finger to a fatal form called limb body wall complex (LBWC). Reported cases of ABS with LBWC are very few. The spectrum of anomalies depends on which part gets entrapped and at what point of gestation. Hence, the clinical presentation can be extremely variable. Early detection of such cases using sonology is really challenging due to the small size of the fibrotic bands. Here, we present a case of amniotic band syndrome with LBWC in a fetus at 24 weeks of gestation, which was referred for an autopsy. The fetus also showed scoliosis, gastroschisis, lumbosacral meningocele, congenital talipes equinovarus, and cleft palate, thus having features of placenta cranial and placenta abdominal phenotype which is very rare.

Situs inversus.

Situs inversus is a rare condition with a genetic predisposition, where in organs are transposed from their normal location to the opposite side of the body with an incidence of 1 in 10000 live births. If Situs Inversus is associated with other congenital anomalies the survival rate is low. So prenatal diagnosis is essential to detect any associated anomalies. During routine fetal autopsies conducted in the department of anatomy, Mysore medical college, Mysore, a rare interesting case of still born baby with gestational age of 20 weeks was observed. Autopsy findings of external examination revealed kyphosis in thoracic region. Thoracotomy revealed heart on the right side (dextrocardia). Laparotomy revealed that the left lobe of liver was bigger than the right. The gall bladder was present on the visceral surface of the left lobe of liver, stomach was on right side, duodenum on left side, pancreas and spleen were on the right side. There was agenesis of right kidney, right ureter and both suprarenal glands. All the above findings correlate with the condition situs inversus. Situs inversus is a rare condition with a genetic predisposition, it’s etiology lies in the mutation of chromosome no 12, which is critical for recognition of right sidedness.1,2 Even though there is transposition of organs in situs inversus, the survival rate is good but if situs inversus is associated with other congenital anomalies the survival rate is low. So prenatal diagnosis is essential to detect any associated anomalies to bring down mortality rate.

Glomerulogenesis: Can it predict the gestational age: A study of 176 fetuses.

Background: Accurate assessment of gestational age of fetuses is essential from both clinical and medico-legal point of view. Crown-rump length, crown-heel length, foot length, and the weight of the fetus are the commonly used parameters for fetal age assessment. However, this estimate often lacks accuracy and sometimes is necessary to combine other data. An analysis of the embryological development of nephrons in the kidney can assist in this determination. Objective : To correlate the gestational age with the histological study of sequential development of nephrons in fetal kidney. Materials and Methods: This study included 176 fetuses delivered between June 2009 and June 2011 and aged from 12 to 40 weeks. The number of glomerular generations counted in hematoxylin and eosin-stained microscopic sections of the kidneys were correlated with the reported period of gestation based on obstetrical methods. Regression analysis was used to determine the statistical significance of the correlation. Results: A high degree of statistically significant correlation was observed between the period of gestation and the number of glomerular generations (P value < 0.0001). Conclusion: The histological assessment of the number of glomerular generations in kidney can be used as a reliable method of estimating fetal age.

Congenital extraskeletal Ewing's sarcoma of chest wall - A rare case report.

Congenital extraskeletal Ewing's sarcoma or peripheral primitive neuroectodermal tumor is an extremely uncommon and invariably fatal tumor. We report a case of extraskeletal congenital Ewing's sarcoma in a female fetus delivered at 34 weeks of gestation who died immediately after birth. In English literature, majority of cases of Ewing's sarcoma in neonates reported were skeletal. To the best of our knowledge, very few cases of extra-skeletal Ewing's sarcoma in neonates are reported in the literature.