Objective: To summarize the clinicopathological factors related to perinatal fetal death and to evaluate importance of fetal autopsy and placental pathology. Methods: The clinicopathological data of 105 perinatal fetal deaths in Beijing Haidian Maternal and Child Health Hospital from November 2012 to December 2020 were retrospectively analyzed. Relevant literature was also reviewed. Results: The maternal age of the deceased fetuses ranged from 22 to 43 years with the average (31.35±4.04 years), and the gestational weeks were 28-40⁺⁶ weeks. Among them, 101 were singleton cases and 4 twin cases. 103 fetuses died in uterus and 2 died during delivery. Relevant factors analysis of the 105 perinatal fetal deaths showed that 86 cases (81.9%, 86/105) were related to umbilical cord/placental abnormality, 10 cases (9.5%, 10/105) uterine infection, 6 cases (5.7%, 6/105) fetal factors, 1 case was fetal maternal blood transfusion syndrome, 1 case twin blood transfusion syndrome, and 1 case died of complete uterine rupture. Among the 86 cases related to umbilical cord/placental abnormality, the diagnosis was most often based on the gross examination of placenta. The most common cause of death was umbilical cord torsion with thin root, followed by placental abruption, tight umbilical cord winding, vascular rupture and umbilical cord true knot. The morphology of placenta revealed mainly functional changes. Among the 10 cases related to intrauterine infections, the placenta generally showed lobular placental edema. The morphological characteristics of ascending infection were mainly acute chorioamnionitis, and the morphological characteristics of blood-borne infection were mainly acute or chronic villitis, as well as villous interstitial inflammation. Identification of viral inclusions suggested viral etiology, while the final diagnosis was relied on laboratory testing. Among the 6 cases related to fetal abnormality, the diagnostic value of placenta was limited and the diagnosis could be made with fetal autopsy. Conclusion: The causes of perinatal fetal death are complex, diverse, and often the synergistic result of multiple factors. Fetal autopsy and placental pathology are the key technical means to identify the cause of death and deserve more attention and utilization.
Adult ; Autopsy ; Child ; Female ; Fetal Death/etiology* ; Fetus/pathology* ; Gestational Age ; Humans ; Placenta/pathology* ; Pregnancy ; Retrospective Studies ; Young Adult

We reviewed the data of 38 neonates who died of respiratory failure. Paraffin sections of the autopsy lung samples were examined with HE staining or immunolabeling for CD34, CD68 and CK to observe the development of the pulmonary vessels and detect potential pulmonary vascular diseases (PVDs). Five cases were identified to have PVDs, including pulmonary hypertensive vascular remodeling in 3 cases and alveolar capillary dysplasia in 2 cases. The result indicated that PVD was one of the important reasons for respiratory failure in these neonates.
Death ; Humans ; Infant, Newborn ; Lung ; pathology ; Lung Diseases ; diagnosis ; Persistent Fetal Circulation Syndrome ; pathology ; Pulmonary Alveoli ; abnormalities ; pathology ; Respiratory Insufficiency ; mortality ; Vascular Diseases ; diagnosis ; Vascular Remodeling

Acute atherosis is unique vascular changes of the placenta associated with poor placentation. It is characterized by subendothelial lipid-filled foam cells, fibrinoid necrosis of the arterial wall, perivascular lymphocytic infiltration, and it is histologically similar to early-stage atherosclerosis. Acute atherosis is rare in normal pregnancies, but is frequently observed in non- transformed spiral arteries in abnormal pregnancies, such as preeclampsia, small for gestational age (SGA), fetal death, spontaneous preterm labor and preterm premature rupture of membranes. In preeclampsia, spiral arteries fail to develop physiologic transformation and retain thick walls and a narrow lumen. Failure of physiologic transformation of spiral arteries is believed to be the main cause of uteroplacental ischemia, which can lead to the production of anti-angiogenic factors and induce endothelial dysfunction and eventually predispose the pregnancy to preeclampsia. Acute atherosis is more frequently observed in the spiral arteries of the decidua of the placenta (parietalis or basalis) than in the decidual or myometrial segments of the placental bed. The presence and deeper location of acute atherosis is associated with poorer pregnancy outcomes, more severe disease, earlier onset of preeclampsia, and a greater frequency of SGA neonates in patients with preeclampsia. Moreover, the idea that the presence of acute atherosis in the placenta may increase the risk of future cardiovascular disease in women with a history of preeclampsia is of growing concern. Therefore, placental examination is crucial for retrospective investigation of pregnancy complications and outcomes, and accurate placental pathology based on universal diagnostic criteria in patients with abnormal pregnancies is essential for clinicopathologic correlation.
Arteries* ; Atherosclerosis ; Cardiovascular Diseases ; Cholesterol ; Decidua ; Female ; Fetal Death ; Foam Cells ; Gestational Age ; Humans ; Infant, Newborn ; Ischemia ; Membranes ; Necrosis ; Obstetric Labor, Premature ; Pathology ; Placenta ; Placentation ; Pre-Eclampsia ; Pregnancy ; Pregnancy Complications ; Pregnancy Outcome ; Retrospective Studies ; Rupture

OBJECTIVETo investigate the clinicopathological characteristics, diagnostic criteria and differential diagnosis of placental chorioangioma.

METHODSTwenty-five cases of placental chorioangioma were analyzed for their clinical data, histomorphology and immumohisto chemical staining. Relevant literature was reviewed.

RESULTSThe average age of the 25 patients was 29 years. Fourteen patients had full-term pregnancy, 10 had preterm labor, and 1 had intrauterine fetal death. Nineteen patients had pregnancy complications. The tumors presented as red or dusty pink nodules with clear borders. The tumor size ranged from 1 to 16 cm. Microscopically, the tumors possessed abundant capillaries or cavernous blood spaces lined by hyperplastic endothelial cells. These cells were positive for CD34 and Ki-67 index < 10%.

CONCLUSIONSPlacental chorioangioma is a rare benign tumor of the placenta, and is associated with various pregnancy complications. Misdiagnosis of cell-rich type tumor should be avoided.

Adult ; Diagnosis, Differential ; Endothelial Cells ; pathology ; Female ; Fetal Death ; Hemangioma ; pathology ; Humans ; Infant, Newborn ; Placenta ; pathology ; Placenta Diseases ; pathology ; Pregnancy ; Pregnancy Complications, Neoplastic ; pathology ; Stillbirth

Holoprosencephaly (HPE) and polycystic kidney disease (PKD) are genetically heterogeneous anomalies which can make up part of various syndromes or chromosomal anomalies. Due to the rapid lethality prognosis, early and precise prenatal diagnosis would be of great value. This case report describes extensive PKD involvement, already present in utero, in a patient with HPE and subdural effusion visible by MR imaging. The detailed anatomic information obtained by the MR imaging can guide the surgical planning and can aid antenatal counseling.
Adult ; Female ; Fetal Death ; Holoprosencephaly/complications/*diagnosis/embryology/pathology ; Humans ; Magnetic Resonance Imaging/*methods ; Polycystic Kidney Diseases/complications/*diagnosis/embryology/pathology ; Pregnancy ; Prenatal Diagnosis/*methods

OBJECTIVETo study the characteristics of autopsies in medical dispute cases, with respect to class of hospitals, clinical units concerned, age of deceased and cause of death.

METHODSTwo hundred and seventy-five autopsies performed on medical dispute cases during the period from January 1, 2002 to September 30, 2008 at the Department of Pathology, Health Science Center, Peking University, China were retrospectively reviewed.

RESULTSDuring the period of study, the number of autopsies performed on medical dispute cases gradually increased. Medical dispute cases happened more often in surgical, obstetric and gynecology departments of grade II and III hospitals, as well as emergency departments of grade I hospitals. Perinatal death in infants of less than 1 year old more frequently caused medical dispute than death occurring in other age groups. According to the International Classification of Diseases (ICD10), disorders of the circulatory system, perinatal illnesses, external injury or iatrogenic conditions represented the major categories of cause of death. In general, the vast majority was due to natural causes and only 13.5% were related to iatrogenic reasons or medical negligence. Pathologic diagnosis of sudden coronary death, myocardial infarction and viral myocarditis should only be made with strict diagnostic criteria.

CONCLUSIONSAutopsies for medical dispute cases can help to delineate the cause of death and provide evidence for further clarification. Meticulous autopsy techniques, application of strict diagnostic criteria and detailed analysis of cause of death are key steps in achieving a high quality service in this area.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Autopsy ; Cause of Death ; Child ; Child, Preschool ; Dissent and Disputes ; Female ; Fetal Diseases ; pathology ; Humans ; Infant ; Infant, Newborn ; Male ; Malpractice ; Middle Aged ; Myocardial Infarction ; pathology ; Retrospective Studies ; Young Adult

OBJECTIVETo characterize the risks and histopathological features of parvovirus B19 infection of infants in perinatal period.

METHODSRoutine pathological examination was performed on 1 neonate, 2 dead fetuses and 2 placentas using either autopsy or biopsy materials.

RESULTSThe diagnostic intranuclear inclusions were found in erythroblasts in the bone marrow, liver, spleen and lungs in one case, in the spleen and liver in one case, in the spleen in one case, and in the placentas in two cases.

CONCLUSIONSSevere hemolytic anemia or fetal hydrop or hemophagocytosis caused by the infection of parvovirus B19 can lead to death of infected neonates and fetus. Pathological confirmation of parvovirus B19 infection relies on the identification of erythroblasts containing the diagnostic intranuclear inclusions.

Anemia ; pathology ; virology ; Autopsy ; Biopsy ; Erythema Infectiosum ; blood ; pathology ; virology ; Erythroblasts ; ultrastructure ; Female ; Fetal Death ; Fetus ; Humans ; Hydrops Fetalis ; pathology ; virology ; Inclusion Bodies ; ultrastructure ; Infant, Newborn ; Lymphohistiocytosis, Hemophagocytic ; pathology ; virology ; Parvovirus B19, Human ; isolation & purification ; Placenta ; pathology ; virology ; Pregnancy ; Stillbirth

OBJECTIVETo investigate the practical possibility of inducing dendritic cells (DCs) from mononuclear cells in the lost blood during operation of hepatocellular carcinoma (HCC) patients, and attempted to find a new source of precursor cells for the personalized immunotherapy based on DCs.

METHODSCollected lost blood during hepatectomy from 9 HCC patients and human cord blood from 8 cases of healthy donors undergoing caesarean section. Their mononuclear cells were divided into monocytes and nonadherent lymphocytes. RhGM-CSF and rhIL-4 were administered to induce the monocytes differentiation into DCs, and then loaded with different antigens (lysate antigen of autologous liver cancer cells and cell line SMMC-7721 cells). The lymphocytes were induced into cytokine-induced killer cells (CIK) with IL-2, CD3-Ab, gamma-IFN and PHA. MTT assay was performed to detect the proliferation rate of T lymphocytes mediated by DC and the cytotoxicity of CIK to liver cancer cells.

RESULTSDCs induced from monocytes of the intra-operative lost blood possessed typical morphology and phenotypes. Compared with the DCs from cord blood, the DCs from intra-operative lost blood expressed lower level of surface markers, but both could effectively induce proliferation of CIK and enhance the cytotoxicity of activated CIK against liver cancer cells at similar levels. When the DCs from lost blood and their counterpart from cord blood were both loaded with autologous tumor cell antigen, the proliferation rates of CIK were (388.9 +/- 137.3)% and (315.1 +/- 44.5)%, respectively, and the killing rates against tumor cells were (87.1 +/- 8.0)% and (90.0 +/- 5.1)%, respectively. When the two similar DC groups were loaded with lysate antigen of SMMC-7721 cells, the proliferation rates of CIK were (239.9 +/- 48.7)% and (226.3 +/- 32.3)%, respectively, and the killing rates against tumor cells were (76.4 +/- 7.9)% and (81.1 +/- 4.3)%, respectively. There were no significant differences between those two DC groups. The data also showed that the proliferation and cytotoxicity of CIK induced by DCs loaded with autologous antigen were higher than that of DCs loaded with SMMC-7721 antigen.

CONCLUSIONMononuclear cells separated from intra-operative lost blood of HCC patients can be induced into mature DCs, which can effectively activate CIK and significantly increase its killing effect on the liver cancer cells, and may become a new source of DCs to study and develop vaccines for clinical application.

Blood Loss, Surgical ; Cell Death ; Cell Line, Tumor ; Cell Proliferation ; Cytokine-Induced Killer Cells ; cytology ; immunology ; metabolism ; Cytokines ; metabolism ; Cytotoxicity, Immunologic ; immunology ; Dendritic Cells ; cytology ; immunology ; metabolism ; Fetal Blood ; Humans ; Liver Neoplasms ; blood ; immunology ; pathology ; surgery ; Tumor Cells, Cultured

OBJECTIVE: To investigate the clinical characteristics and etiologic factors of pregnancies with fetal death in utero (FDIU). METHODS: Retrospective review of medical records of 184 pregnancies with FDIU between March 1996 and March 2006 was conducted and descriptive analysis was done. Medical records were unavailable in 14 cases which were excluded in the analysis of etiology and diagnostic evaluation. RESULTS: The overall incidence was 1.31%. There was no significant difference in the yearly incidence during the study period. Age distribution of FDIU was between 18 and 44 and the incidence was highest in 25~29 year-old age group. The risk analysis showed statistically significant risk in the age group under 25 (OR, 2.455) and 25~29 (OR, 1.590) compared to 30~34 year-old age group. The risk of age group beyond 35 has a tendency to increase but was not statistically significant. FDIU was the most prevalent (38.58%) among pregnancies less than 29 weeks of gestation. Most of cases were delivered vaginally (86.5%). Etiologic factors included unexplained causes (37.1%), fetal factors (29.4%), placental and cord factors (18.2%) and maternal factors (15.3%). Autopsy was done in 128 cases (75.3%) and placental pathology was examined in 148 cases (87.1%). Among the workups done, autopsy and placental pathology were the most informative. CONCLUSION: Despite the advance of prenatal care, the incidence of FDIU was steady throughout the study period. The etiology of the largest proportion was unexplained. Once FDIU is diagnosed, prompt delivery should be done and appropriate diagnostic tests should be offered to aid in next pregnancy.
Age Distribution ; Autopsy ; Cord Factors ; Diagnostic Tests, Routine ; Fetal Death* ; Humans ; Incidence ; Medical Records ; Pathology ; Pregnancy ; Prenatal Care ; Retrospective Studies ; Stillbirth

The objective of this investigation was to evaluate the influence of gestational age at exposure on the prenatal effects of gamma-radiation. Pregnant ICR mice were exposed to a single dose of 2.0 Gy gamma-radiation at a gestational 2.5 to 15.5 days post-coitus (p.c.). The animals were sacrificed on day 18 of gestation and the fetuses were examined for mortality, growth retardation, change in head size and any other morphological abnormalities. The only demonstrable effect of irradiation during the preimplantation period was an increase in prenatal mortality. Resorptions were maximal on post-exposure day 2.5 after conception. The pre-implantation irradiated embryos which survived did not show any major fetal abnormalities. Small head, growth retardation, cleft palate, dilatation of the cerebral ventricle, dilatation of the renal pelvis and abnormalities of the extremities and tail were prominent after exposure during the organogenesis period, especially on day 11.5 of gestation. Our results indicate that the late period of organogenesis in the mouse is a particularly sensitive phase in terms of the development of the brain, skull and extremities.
Abnormalities, Radiation-Induced/*pathology ; Animals ; Bone and Bones/abnormalities/radiation effects ; Female ; Fetal Death ; *Gamma Rays ; *Gestational Age ; Mice ; Mice, Inbred ICR ; Pregnancy ; Pregnancy, Animal/*radiation effects ; Prenatal Exposure Delayed Effects