2015 Annual Meeting

SC47- Late Intrauterine Demise:  Placental and Fetal Postmortem Pathology

2015 Annual Meeting

Room CC 309, March 25 2015, 1:30pm to 5:30pm

Theonia Boyd, Drucilla Roberts

Educational Objective


This course is designed primarily to offer practicing general pathologists and pathologists-in-training a framework for approaching stillborn fetuses and/or their placentas, in order to synthesize clinical and pathologic information to arrive at a definite or likely cause of demise, and to offer commentary regarding increased recurrence risks and suggestions for ancillary or future testing when applicable. Categories and examples of topics to be covered Catastrophic events: minutes to hours Traumatic placental abruption Ruptured vasa previa Uterine rupture Cord prolapse Maternal shock Maternal respiratory arrest Acute mechanisms of demise: hours to a day Spontaneous placental abruption Fetomaternal hemorrhage Subacute mechanisms of demise: days to a week Ascending infection Non acute umbilical blood flow restriction Chronic mechanisms of demise: weeks to months Uteroplacental malperfusion Fetal cardiac failure Hemolytic anemia Extensive chronic villitis Massive perivillous fibrin Multifetal gestation: special considerations Assessing the interval between the onset of stress and demise Thymic and adrenal stress involution Assessing the interval between demise and delivery External fetal maceration Internal fetal autolysis Placental fetal vascular involution Medicolegal considerations Reporting autopsy and placental findings, documenting communication What if you’re presented a subpoena to testify regarding your report? Ancillary testing Cytogenetics, molecular genetics Infectious disease testing Maternal testing Autopsy and placental reporting Introduction of templates included in handout Upon completion of this educational activity, participants should be able to:

  1. Identify autopsy and/or features that help time a) the onset of intrauterine stress prior to demise and b) the interval between demise and delivery
  2. Utilize published tables, graphs and charts to assist in assessing elements of timing in intrauterine demise outlined above
  3. Report in a concise and synthetic manner autopsy and placental findings that effectively convey mechanisms of intrauterine demise
  4. Assess sporadic vs. potentially recurrent mechanisms of intrauterine demise

Session Credits: CME = 3 / SAMs = N/A


Speaker: Theonia K. Boyd, MD, Boston Children?s Hospital, Brigham and Women?s Hospital, Harvard Medical School, Boston, MA
Access to Handouts
Speaker: Drucilla Roberts, MD, Massachusetts General Hospital, Harvard Medical School, Boston, MA


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