Clinicopathological study of germinal matrix hemorrhage, pontosubicular necrosis, and periventricular leukomalacia in stillborn.

The occurrence of germinal matrix hemorrhage (GMH), pontosubicular necrosis (PSN), and periventricular leukomalacia (PVL) was evaluated in 58 stillborn, among whom 23 (40%) showed one or more lesions. A comparative study of neuropathological findings and obstetrical histories in stillborn beyond 26 weeks of gestation showed a greater frequency of damage when the pregnancies had been complicated. The pathogenesis of PSN is disputed. As PSN was found in stillborn (13 cases), hyperoxia is not an essential pathogenetic factor. PSN may represent a form of anoxic encephalopathy. However, PSN was found as an isolated lesion in an infant of a diabetic mother and in most cases of intrauterine growth retardation; hypoglycemia may therefore be involved in the pathogenesis. Ultrasound examinations of living neonates have indicated the prenatal occurrence of GMH in some cases, and our study opens the possibility that there is intrauterine involvement of PVL and PSN as well. Consequently, cerebral lesions diagnosed in newborn may have occurred in utero.