Clinical value of postnatal autopsy and genetics consultation in fetal death

The aim of the present study was to investigate the clinical use of postnatal autopsy and genetics consultation in cases of fetal death in a teaching hospital. A retrospective analysis of medical records including pathology and genetics reports was performed in all cases of fetal death in which a woman delivered at Ben Taub General Hospital, Houston, Texas over a 2-year period. Cases were excluded when gestational age of the fetus was less than 20 weeks. Fetuses were only included when the 1- and 5-min Apgar scores were 0 and 0, respectively. There were 139 fetal deaths and 12,209 live born infants during the study period (stillbirth rate 1.125%). Although pathology services were used in 96.2%, a genetics consultation was obtained in only 12% of cases. Fetal autopsy provided a certain cause of fetal death in 19.4%, a probable cause for death in 36.3%, and was inconclusive in 44.3%. Among the cases in which a genetics consultation was obtained, a certain and probable cause for fetal death was found in 20% and 20% of cases, respectively. The utilization of genetics consultation was found to be independent of multiple clinical variables examined including ultrasound data, identification of maceration, and training level of resident. Our data show a frequent use of pathologic examination in cases of fetal death and an infrequent use of genetics consultation services. The request for genetics consultation seemed to have been made at random.

Isolated mild fetal cerebral ventriculomegaly: clinical course and outcome

PURPOSE

To assess the outcome of fetuses with isolated mild ventriculomegaly (IMVM).

MATERIALS AND METHODS

The clinical course of 44 fetuses with IMVM was investigated. Cognitive and motor development was classified as normal or delayed.

RESULTS

Clinical data were available for 37 subjects. Three (8%) neonates died. Of the 34 living children, follow-up was limited (< 9 months) in six and the clinical course beyond the 1st year of life was established in 28. Twenty-two (79%) of the 28 children are developing normally, whereas six (21%) are developmentally delayed. More than 90% of fetuses with ventricular atrial diameter of 10-11 mm are normal. Seventy-five percent of fetuses with IMVM were male. With exclusion of the six children with limited follow-up, 78% of boys older than 1 year are developmentally normal compared with only 50% of girls.

CONCLUSION

The majority of living children with prenatally detected IMVM are developmentally normal, especially those with borderline ventriculomegaly. Gender differences in prevalence and outcome deserve further investigation.