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We compared the pathologic and ultrasonographic findings of 31 first trimester spontaneous abortions to determine the benefits of such studies. The ultrasound diagnoses included empty gestational sac (n = 11), intrauterine fetal death (n = 11), abortion in progress or incomplete abortion (n = 8), and live embryo (n = 1). Two subgroups of empty sacs were identified by pathologic examination. Embryonic development appeared to be more advanced in one group as indicated by the presence of embryonic red blood cells (RBC's) in the placental vessels. Although an embryo or fetus was identified more frequently by sonar than by pathologic examination, we were able to diagnose developmental anomalies in small embryos that current ultrasound equipment cannot resolve. Such anomalies were identified even in the presence of fetal heart activity. Pathologic examination was also informative when heavy bleeding obscured the contents of the uterine cavity to sonar and was thus supplementary of a suboptimal ultrasound examination. Placental examination proved to be reliable in assessing gestational age at the time of embryonic/fetal death. There was a good correlation between RBC morphology and sonographic measurement of crown-rump length. First trimester ultrasound and pathologic examination of the embryo and placenta are informative and complement each other.

Bronchopleural fistula (BPF) produced by endotracheal suction catheter is a known cause of persistent pneumothorax in preterm infants in intensive care nurseries. This report describes the pulmonary pathology of a neonate who had sustained this injury. The observation suggests that the abnormal airflow results in severe damage of the involved lobe and an unusually mild bronchopulmonary dysplasia in the rest of the lung. This is in agreement with the fact that BPF acts as the path of least resistance for the oxygen-rich air from the ventilator.

Sixty-one instances of congenital anomalies identified prenatally by ultrasound were reviewed to determine whether autopsy provided important additional information. An important finding was defined as one which would affect: 1) genetic counseling; 2) diagnosis of a syndrome; 3) determination of etiology or pathogenetic mechanism of the anomaly; or 4) interpretation of severity of the anomalies. In 28 cases (46%), post-mortem examination provided such information. All of these infants had multiple anomalies; correlations with oligohydramnios and poor fetal outcome were noted. Autopsy provided no additional meaningful information in 30 cases (49%), the majority (77%) of whom had isolated anomalies. In 3 cases (5%), due to tissue autolysis, autopsy provided less information than the previous ultrasound. Although most fetal anomalies are readily diagnosed by ultrasound, we found that post-mortem examination is still necessary: 1) to confirm a prenatal diagnosis; 2) to delineate multiple anomalies; 3) when the ultrasound examination is limited by oligohydramnios; and 4) to obtain tissue for microscopic examination, cytogenetic and biochemical analysis, if these studies have not been performed prenatally.