Croatian Society of Gynaecology and Obstetrics, and Croatian Society of Perinatal Medicine of Croatian Medical Association
Abstract
Pažljivo učinjena obdukcija u slučaju perinatalne smrti je vrlo važna jer daje značajne podatke za obitelj, liječnike i društvenu zajednicu u cjelini. Standardizirani protokoli koje bi valjalo slijediti, kako bi obavljanje perinatalne obdukcije dalo što pouzdanije podatke, sadržavaju fotografiranje, rentgenske slike, kariotipizaciju (u odabranim slučajevima), makroskopsku i histološku pretragu posteljice, vanjski pregled i obdukciju fetusa (novorođenčeta) te histološku pretragu njegovih organa. Prema podacima iz literature mrtvorođenost (definirana kao smrt in utero nakon 22. tjedna gestacije) sačinjava oko 50% perinatalnih smrti, a slični podaci u posljednjih nekoliko godina vrijede i za Hrvatsku. Obdukcija mrtvorođene djece (uz pretragu posteljice) u velikom broju slučajeva otkriva uzrok smrti, no vremenu proteklom od trenutka smrti do poroda posvećuje se nedovoljna pažnja. Prema istraživanjima o tome i njihovim rezultatima, vrijeme proteklo od trenutka intrauterine smrti do poroda se može prilično točno odrediti, a što može imati veliku važnost u mogućim sudskim sporovima. Nabrojani su najpouzdaniji makroskopski (dobiveni vanjskim pregledom fetusa) i histološki pokazatelji (dobiveni histološkom pretragom tkiva organa preuzetih tijekom obdukcije) vremena proteklog od trenutka smrti in utero do poroda, kao i najpouzdaniji histološki pokazatelji istog utvrđeni histološkom pretragom posteljičnog tkiva.Skillful perinatal autopsy is extremely important because it provides informations relevant to the family, the physician and the community. Standardized protocols that should be followed to gain reliable informations contain photographs, radiograms, karyotyping (in selected cases), gross and histologic examination of the placenta, gross examination and autopsy of the fetus (newborn). According to the literature, stillbirth (defined as delivery of a fetus who has died in utero after 20 weeks’ gestation) accounts for about 50% of all perinatal deaths. Similar data were obtained also for Croatia in the past few years (stillbirth defined as gestational age >22 weeks and birthweight of 500 g and more). Gross examination should be performed in all cases of perinatal death, as well as the autopsy, because it reveals the cause of death in the majority of cases. In cases of stillbirth not enough attention is paid to estimation of the time of fetal death. Gross examination of the stillborn and histological examination of samples of fetal organs taken during the autopsy (with pathological examina¬tion of the placenta) enables us to assess fairly accurately the duration of time period between intrauterine death and birth. This can also have imporant medico-legal implications. The best gross and histologic predictors of the time between fetal death and delivery are listed, as well the histologic features of placenta that can be used as good predictors when timing intrauterine death
