1. Mechanisms of death in structurally normal stillbirths.
- Author
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Pacora, Percy, Romero, Roberto, Jaiman, Sunil, Erez, Offer, Bhatti, Gaurav, Panaitescu, Bogdan, Benshalom-Tirosh, Neta, Jung, Eun Jung, Hsu, Chaur-Dong, Hassan, Sonia S., Yeo, Lami, and Kadar, Nicholas
- Subjects
PERINATAL death ,AMNIOCENTESIS ,AMNIOTIC liquid ,BIOMARKERS ,BRAIN injuries ,CYTOSKELETAL proteins ,ERYTHROPOIETIN ,FETAL malnutrition ,FETAL anoxia ,IMMUNOASSAY ,IMMUNOHISTOCHEMISTRY ,LONGITUDINAL method ,CARDIOMYOPATHIES ,SCIENTIFIC observation ,STATISTICAL sampling ,RETROSPECTIVE studies ,TROPONIN ,DISEASE complications ,DIAGNOSIS - Abstract
Objectives: To investigate mechanisms of in utero death in normally formed fetuses by measuring amniotic fluid (AF) biomarkers for hypoxia (erythropoietin [EPO]), myocardial damage (cardiac troponin I [cTnI]) and brain injury (glial fibrillary acidic protein [GFAP]), correlated with risk factors for fetal death and placental histopathology. Methods: This retrospective, observational cohort study included intrauterine deaths with transabdominal amniocentesis prior to induction of labor. Women with a normal pregnancy and an indicated amniocentesis at term were randomly selected as controls. AF was assayed for EPO, cTnI and GFAP using commercial immunoassays. Placental histopathology was reviewed, and CD15-immunohistochemistry was used. Analyte concentrations >90
th centile for controls were considered "raised". Raised AF EPO, AF cTnI and AF GFAP concentrations were considered evidence of hypoxia, myocardial and brain injury, respectively. Results: There were 60 cases and 60 controls. Hypoxia was present in 88% (53/60), myocardial damage in 70% (42/60) and brain injury in 45% (27/60) of fetal deaths. Hypoxic fetuses had evidence of myocardial injury, brain injury or both in 77% (41/53), 49% (26/53) and 13% (7/53) of cases, respectively. Histopathological evidence for placental dysfunction was found in 74% (43/58) of these cases. Conclusion: Hypoxia, secondary to placental dysfunction, was found to be the mechanism of death in the majority of fetal deaths among structurally normal fetuses. Ninety-one percent of hypoxic fetal deaths sustained brain, myocardial or both brain and myocardial injuries in utero. Hypoxic myocardial injury was an attributable mechanism of death in 70% of the cases. Non-hypoxic cases may be caused by cardiac arrhythmia secondary to a cardiac conduction defect. [ABSTRACT FROM AUTHOR]- Published
- 2019
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