Tidsskrift for den Norske laegeforening : tidsskrift for praktisk medicin, ny raekke · 2001
[Finding the cause of death in intrauterine death--which examination should be done?].
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Frøen J F, Vege A, Ormerod E, Stray-Pedersen B
Аннотация
BACKGROUND: The incidence of antepartum fetal death after 22 weeks of gestation is about 0.4% in Oslo, Norway. Screening routines will decide how many cases will remain unexplained. One quarter are diagnosed as Sudden Intrauterine Unexplained Death (SIUD). Precise knowledge of the cause of death is needed as a basis for counselling, prevention and treatment.
MATERIAL AND METHODS: The implementation of diagnostic routines in stillbirths in Oslo from 1986 to 1995 was examined. A structured review has been prepared and new guidelines for diagnostic procedures have been adopted by The Perinatal Committees of Oslo and Akershus.
RESULTS: Autopsies and placental investigations were performed in 88% of intrauterine deaths. Among SIUD cases (all autopsied), infectious causes were examined and excluded in 93%. In contrast Kleihauer-Betke test was performed in only 17%, autoantibodies explored in 24%, and glucose tolerance tested in 36% of cases. The recommended laboratory investigations are: autopsy, placental investigation, bacteriological culture and investigations of infections such as Toxoplasma gondii, cytomegalovirus, parvovirus B19 and Listeria monocytogenes, Kleihauer-Betke test, screening for diabetes, chromosome analysis of amniotic fluid and placental biopsy, and serology of antiphospholipids.
INTERPRETATION: Both the content and implementation of diagnostic routines in the cases of antepartum fetal death has not been optimal in our region; there is need for a change.
MATERIAL AND METHODS: The implementation of diagnostic routines in stillbirths in Oslo from 1986 to 1995 was examined. A structured review has been prepared and new guidelines for diagnostic procedures have been adopted by The Perinatal Committees of Oslo and Akershus.
RESULTS: Autopsies and placental investigations were performed in 88% of intrauterine deaths. Among SIUD cases (all autopsied), infectious causes were examined and excluded in 93%. In contrast Kleihauer-Betke test was performed in only 17%, autoantibodies explored in 24%, and glucose tolerance tested in 36% of cases. The recommended laboratory investigations are: autopsy, placental investigation, bacteriological culture and investigations of infections such as Toxoplasma gondii, cytomegalovirus, parvovirus B19 and Listeria monocytogenes, Kleihauer-Betke test, screening for diabetes, chromosome analysis of amniotic fluid and placental biopsy, and serology of antiphospholipids.
INTERPRETATION: Both the content and implementation of diagnostic routines in the cases of antepartum fetal death has not been optimal in our region; there is need for a change.