| Sažetak | Objectives: to determine causes of stillbirth according to ReCoDe classification system, with emphasis on stillbirth cases classified only as "mors fetus" by clinicians.
Materials and methods: retrospective study over a time span of 7 years evaluated 115 stillbirths. The collected data included pathological data, both autopsy reports and placental pathological reports and clinical information from the autopsy request forms.
All of the stillbirth cases were allocated into one of the ReCoDe category and subgroups. Autopsy findings were summarized into seven categories (Signs of hypoxia, Infection, Malformations, Maceration, Umbilical cord, Signs of hydrops and Rh iso-immunization) and each stillbirth case was allocated into one, the most significant category. Finally the clinical information were summarized into ten categories (Mors fetus, Prematurity + Mors fetus, Malformations, Placenta abruption, Infection, Rhesus (Rh) - isoimmunization, Hydrops, Umbilical cord strangulation or knot, Maternal disease, Twin pregnancy) and each stillbirth was allocated into one category.
Results: 60% of stillbirths were males, 73% were classified as late stillbirth (≥28th w.g.) and 77.4% of all cases were preterm babies (<37th w.g.).
The most common ReCoDe category was amniotic fluid (23.5%), all of the cases recorded were chorioamnionitis. Within the "Fetus" group of ReCoDe category, congenital anomalies were most prevalent (60.9%). "Preterm baby" was the most common clinical information (39.1%), while "Signs of hypoxia" was the most common autopsy finding (36.5%). The second most common clinical information was "mors fetus" (19.1%). We could allocate all cases of "mors fetus" in one of the autopsy categories, where "Signs of hypoxia" was the most common one (63.6%). Furthermore, preterm stillbirth was most often categorized within the ReCoDe "Amniotic fluid" group (28.1%) while term stillbirths were most often categorized within the ReCoDe group "Umbilical cord" and "Unclassified" (30.8% and 30.8%, respectively).
Conclusion: Pathological investigations are contributing to far more understanding of the causes of stillbirth compared to the clinical diagnosis alone and a proper communication between the clinican and pathologist is cruicial for detailed and accurate diagnosis. |
| Sažetak (hrvatski) | Ciljevi: Odrediti uzroke smrti kod mrtvorođene djece prema ReCoDe klasifikacijskom sustavu, s naglaskom na mrtvorođenčad s uputnom dijagnozom mors fetus kao jedinim kliničkim podatkom.
Materijal i metode: retrospektivno istraživanje obuhvatilo je 115 slučajeva mrtvorođene djece u u vremenskom razdoblju od 7 godina. Analizirani su obdukcijski zapisnici, patohistološki nalazi posteljica te klinički podatci koji su preuzeti iz zahtjeva za obdukciju. Svi slučajevi su klasificirani prema ReCoDe klasifikacijskom sustavu.
Patološke dijagnoze proizašle iz obdukcijskih zapisnika podjeljene su u sedam kategorija (znakovi hipoksije, infekcija, malformacije, maceracija, pupčan vrpca, znakovi hidropsa, Rh- iso-imunizacija), a klinički podatci u deset kategorija (mors fetus, prematurus+mors fetus, malformacije, abrupcija posteljice, infekcija, Rh-isoimunizacija, hidrops, strangulacija pupčanom, vrpcom ili pravi čvor pupčane vrpce, bolesti majke i blizanačke trudnoće), svakom slučaju je dodjeljena jedan od navedenih kategorija patoloških dijagnoza i kliničkih podataka.
Rezultati: 60% mrtvorođenčadi je bilo muškog spola, 73% slučaja spada u kasnu mrtvorođenost (≥28tj. gestacije) , a 77,4% slučajeva su prematurusi (<37tj. gestacije).
Najučestalija ReCoDe kategorija je bila amnionska tekućina (23,5%) a svi zabilježeni slučajevi te kategorije su korioamnionitisi. Kongenitalne anomalije su najučestalija ReCoDe podgrupa u kategoriji "Fetus" (60,9%). Najučestaliji klinički podatak je bio "Prematurus" (39,1%) , a "Znaci hipoksije" najčešći patološki nalaz obdukcije (36,5%). Drugi po učestalosti klinički podatak je bio "mors fetus" (19,1%), a u toj skupini je najčesči patološki nalaz bio "Znaci hipoksije" (63,6%). "Amnionska tekućina" je bila najčešća ReCoDe grupa u skupini prematurusa (28,1%) dok je uzrok smrti terminske mrtvorođenčadi najčešće klasificirana u ReCoDe grupe "Pupčana vrpca" i "Neklasificirano" (30,8% i 30,8%).
Zaključci: Obdukcija i patohistološka analiza ploda i posteljice od iznimne su važnosti u utvrđivanju uzroka smrti mrtvorođene djece, pri čemu ključnu ulogu ima dobra komunikacija i međusobna suradnja patologa i kliničara. |
