Radiography of stillborn infants

Investigating perinatal death: a review of the options when autopsy consent is refused

Autopsy remains the best method of investigating perinatal deaths. Recent years have, however, seen a decline in autopsy rates. This review looks at some of the options available for investigating perinatal deaths when the family decline to give consent for standard autopsy.

Cerebro-osseous-digital syndrome: four new cases of a lethal skeletal dysplasia--distinct from Neu-Laxova Syndrome

Neu-Laxova Syndrome (NLS) is a severe disorder with intrauterine growth retardation, edema, and characteristic face (including microcephaly with receding forehead, protuberant eyes, a flattened nose, deformed ears, cleft palate, and micrognathia). Ichthyosis is often present. Limb anomalies include hypoplastic fingers and syndactyly of fingers and toes. Patients are usually stillborn or die shortly after birth. We report five unrelated patients--four with atypical NLS and one with typical NLS. All five patients were stillbirths. Clinically, the atypical NLS patients showed a large skull; rhizo-, meso-, and acromelia; and hypoplasia of the metacarpals and phalanges. The feet were similarly affected. Radiographically, the atypical patients showed interpediculate narrowing and hypoplastic vertebral bodies. The long bones were stick-like, showing diaphyseal widening that spared the metaphyses and was more pronounced in the lower extremities. The ilia had a half-moon configuration with widening of the sacrosciatic notches. The ischia were vertical and the pubic bone was absent. The typical NLS patient showed microcephaly, normal vertebral body, and long bone ossification, but a pelvic configuration similar to that of the atypical NLS patients. The common and distinguishing clinical and radiographic features are reviewed. Scott et al. [1981: Am J Med Genet 9:165-175] described two patients with NLS with radiographic and clinical findings similar to patients 1-4 reported here. Patients 1-4 of this report lack the typical findings of NLS and likely represent a distinct lethal skeletal dysplasia.

Ultrasound in the perinatal necropsy

Although plain and contrast radiology have become a well established part of the perinatal and fetal necropsy, the role of ultrasound has been less comprehensively explored. We have found a variety of ultrasonographic approaches to be of value in diagnosis, quality control, and teaching. Ultrasound is of particular help where consent for formal necropsy has been declined.

Perinatal postmortem radiography

Despite the heterogeneous nature of congenital defects, an increasing number of aetiologically specific entities are being delineated, which is partly due to the increasing use of radiology. Data concerning the aetiology are especially important to the parents, who need information on the risk of recurrence for future pregnancies. During 1980-1982 a postmortem radiologic investigation was carried out on 514 perinatally dead infants from 22 hospitals in Finland. Pathologic radiologic findings were seen in 30 per cent of the material. Ninety-nine cases had congenital defects, while the rest showed other skeletal or soft tissue abnormalities. Of those with congenital defects, there were 6 osteochondrodysplasias, 16 chromosomal malformation syndromes, 13 autosomal recessive inherited malformation syndromes and 18 multiple malformation syndromes of unknown aetiology. There were also 18 cases with malformation sequences and 10 single malformations with abnormal radiologic findings. Congenital defects due to disruptions were detected in 12 cases and defects due to deformations in 7. The present article includes a review of the radiologic findings in 514 cases, with special reference to the skeletal findings.

The radiology of stillbirths and neonatal deaths

Whole body radiographs were made in a consecutive series of 488 infants who were either stillborn or died within the first month of life; autopsies were done in 378. The radiographs were considered to have been useful, or diagnostic in 16% overall, in 100% of infants with dwarfism, in 40% where there were external malformations; and in 9% where there were no external malformations.

Neonatal death dwarfism--a new form

A new type of neonatal death dwarfism is reported. Although it resembles superficially the metatropic dysplasia group of diseases it has some distinctive radiographic features which help to delineate it as a separate entity.

Thanatophoric dysplasia with cloverleaf-skull. Case report and review of the literature

The radiologic and morphologic features of thanatophoric dysplasia with cloverleaf-skull could be demonstrated in a neonate who died from asphyxia shortly after birth. Occipital bone hemangiomatosis, a typical histomorphologic finding in cloverleaf-skull, is reported for the first time in a thanatophoric dwarf. Our investigations and the discussion of 26 observations of thanatophoric dysplasia with cloverleaf-skull reported since 1967 do not yet allow complete understanding of the pathogenetic relationship of both malformations. They serve, however, to elucidate some crucial unanswered questions which it is suggested should be studied in future observations of thanatophoric dysplasia with cloverleaf-skull.

New forms of neonatal death dwarfism. Report of 3 cases

The term Lethal Neonatal Dwarfism (Death Dwarfism) denotes bone dysplasias which always have a fatal outcome. Three different cases of "new" forms of death dwarfism are reported. A babygram should be a routine examination in all the cases of stillborn babies or those who die soon after the birth. If then the diagnosis cannot be established microscopic investigations of the growth cartilage should be performed.

The value of radiography in perinatal deaths

A prospective study of 100 consecutive stillbirths/perinatal deaths was performed by routine radiography and subsequent autopsy. The object of the study was to correlate the clinical and the autopsy causes of death with any abnormal radiographic findings. A prime objective was to study the incidence of major skeletal abnormalities in the series and to ascertain if routine radiography could be used to detect abnormalities that might require genetic counselling. No skeletal abnormalities or dysplasias were detected that did not have obvious external stigmata. The use of routine radiography on undeformed stillbirths is not recommended.

Cerebroarthrodigital syndrome: a newly recognized formal genesis syndrome in three patients with apparent arthromyodysplasia and sacral agenesis, brain malformation and digital hypoplasia

We describe three patients with a complex syndrome of apparent arthromyodysplasia, dyscephaly, sacral agenesis, and hypoplastic digitis. Cause is unknown, but an environmental cause is suspected on the basis of ergotamine exposure in one case and diazoxide intake in another, together with suggestive similarities to anomalies seen in animals treated with these drugs and to calves with the Australian hydranencephaly/arthrogryposis syndrome caused by Akebane or Aino virus. Pathogenetically the primary defect may be a neural tube-neural crest dysplasia with multiple secondary and tertiary manifestations and deformities.

The early development of the human skeleton: a radiographic study of fetuses impregnated with silver nitrate

The use of a silver nitrate impregnation technique and radiography for delineation of the bones of the developing skeleton is not widely known. Using this method, a study of skeleton development was undertaken over a three-year period and special attention was paid to 20 fetuses under the age of 16 weeks. The dates at which ossification in cartilage occurred and the sequence of bone development were noted. Although the technique may be used to delineate skeletal dysplasias in the stillborn, it is best suited to fetuses aged 9--20 weeks. It may become possible to show the earliest age at which bone dysplasias affect the skeleton though this is speculative at the moment.

Perinatal post-mortem radiography--experience with 2500 cases

A review of 2500 routine post-mortem radiographic examinations of perinates is presented. It is concluded that the procedure is of value in the detection of abnormalities which may have contributed to the death of the perinate and which may have escaped detection at autopsy. The use of contrast agents may assist in the evaluation of congenital abnormalities, especially of the cardiovascular system. Post-mortem radiographic examination may be especially helpful in the evaluation of perinates for whom permission for autopsy is denied. Post-mortem radiography may assist in the gathering of statistical data and may provide useful material for teaching and research.

The differential diagnosis of the short-limbed dwarfs presenting at birth

Attention is drawn to the fact that in a number of types of short-limbed dwarfism a precise diagnosis can be made in the neonatal period. Examples are given and the prognostic and genetic implications are discussed. It is important to be able to advise parents of the likely outlook for the infant and of the genetic implication. Early diagnosis is therefore not merely an academic exercise.

Studies of malformation syndromes in man XXXVI: the Pfeiffer syndrome, association with Kleeblattschädel and multiple visceral anomalies. Case report and review

This paper reports sporadic occurrence of the Pfeiffer syndrome with Kleeblattschädel (KS) in a male infant who died at 6 months of pneumonia with signs of increased intracranial pressure and who was found to have hydrocephalus, polymicrogyria, cerebellar herniation, bicuspid aortic valve, a common mesentery, absence of lesser omentum, hypoplasia of gallbladder, a single umbilical artery, and multiple eye defects. This case is presumed to represent a new mutation: in other families the Pfeiffer syndrome has been dominantly inherited. The Pfeiffer syndrome is a form of acrocephalosyndactyly and impresses clinically as a mild form of the Apert syndrome. The Kleeblattschädel is an etiologically non-specific developmental field defect (DFC); about two fifths of 51 known cases have apparent thanatophoric dwarfism and about one fifth are probable or possible examples of the Pfeiffer syndrome. The KS-DFC has also been seen in the syndromes of Carpenter, Apert and Crouzon.