2016 Annual Meeting

SC16-Pathology of the Previable Fetus and Stillborn Infant for the General Pathologist

Room CC 604, March 17 2016, 8:00am to 11:30am

Description

SC16-Pathology of the Previable Fetus and Stillborn Infant for the General Pathologist

Session Credits: 3 CME and 3 SAMs

Faculty: Debra S. Heller, MD, Rutgers New Jersey Medical School, Newark, NJ and Ona M. Faye-Petersen, MD, University of Alabama at Birmingham, Birmingham, AL

Evaluation of previable fetuses and stillborn infants can be challenging, especially for the general practice pathologist and pathology trainees. However, the information obtained from such examinations, particularly when combined with correlative placental examinations, is used not only to explain the cause of fetal demise to the parents, it also often has implications for future pregnancy planning. The importance of an adequate fetal examination and report of more than mere autolysis are emphasized in the guidelines published by the College of American Pathology (Arch Pathol Lab Med. 1997;121(4):368-76.) However, current workload challenges for pathologists may further complicate the evaluation of these cases. As placental pathology is presented in other short courses, this course is designed to give pathologists and pathologists-in-training, who are not sub-specialized in perinatal pathology, a focused, working approach to evaluation of both structurally normal and anomalous fetuses. Case vignettes will be jump off points for the discussions of the more commonly encountered abnormalities. Much of fetal/stillbirth pathology is identifiable by the gross examination, but microscopic examination remains an essential component of the perinatal autopsy and salient microscopic features will be explored. The topics to be covered are: 1-The evaluation of the non-anomalous fetus/stillborn, including what measurements to take; discussion of what is normal; how to estimate timing of intrauterine retention after demise; evaluation for hypoxia and growth restriction; evaluation of cord accidents; and characteristic findings with common maternal conditions such as diabetes and hypertension. 2-The evaluation of the anomalous fetus, including the most common chromosomal aneuploid conditions [trisomies 21, 18, and 13, Turner syndrome (45,X)]; nonmolar triploidy; VACTERL(S) association; a variety of other abnormalities such as omphalocele, gastroschisis, neural tube defect, amniotic disruption and oligohydramnios sequences; and an approach to the hydropic fetus. Due to the sensitive nature of the material, the presentation will not be available on the Web.

Upon completion of this educational activity, participants should be able to:

  1. Utilize an organized and thorough approach to the evaluation of fetuses and stillborns
  2. Describe the main features characterizing the stages of normal maturation of the previable, preterm, and term fetus
  3. Detect a range of anomalous fetal features and appropriately categorize them, to derive the correct or most plausible diagnosis
  4. Discuss the causes and mechanisms involved in the development of fetal hydrops
  5. Better determine the causes of pregnancy loss.

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