Published: 2022-05-27

Pathological features in perinatal autopsy and its relation with clinical and antenatal sonography findings

Aswathy P., Lillykutty Pothen, Renu Thambi, Sankar S.


Background: Perinatal mortality is considered as a yardstick of obstetric and maternal care before and around the time of death. Perinatal autopsy is an inevitable procedure which helps to ascertain the cause of death, identify rare diseases, supplements clinical diagnosis and provide risk estimates for future pregnancies. The aim of the study was to describe the pathological features in perinatal autopsy specimens and to compare the pathological features with clinical and antenatal sonography findings.

Methods: A descriptive study was conducted among 43 perinatal autopsy cases. A thorough perinatal autopsy was done. Detailed maternal medical and obstetric history including the laboratory and USG findings were collected. Collected data analysed using Statistical package for social sciences (SPSS) software.

 Results: The results were grouped into fetal, maternal and placental findings. Congenital anomalies were detected in 20% cases. That included gastrochisis, ebstein anomaly, isolated dextrocardia, hypoplastic left heart syndrome, cleft lip and palate, prune belly syndrome, club foot. Placenta findings observed were chorioamnionitis, placental thrombotic vasculopathy and placental findings in COVID-19 positive cases. The most common maternal comorbidity was hypertension (20.9%). Perinatal mortality was high in those cases with past history of abortions and history of infertility treatment. Full agreement between perinatal autopsy and antenatal USG findings was detected in 36.36% cases. Additional anomalies detected on autopsy was 54.54%.

Conclusions: A thorough clinical history, prenatal ultrasonography and perinatal autopsy features could be described in detail in all the cases. Comparison of finding at autopsy with antenatal ultrasonography finding indicate that ultrasonography finding have only a reasonable value in assessing fetal status. Advanced radiology techniques could be maximum helpful.  


Perinatal death, Perinatal autopsy, Congenital anomaly, Maternal comorbidity, COVID-19

Full Text:



Singh M. Care of the new born revised 8th ed . CBS publishers & distributors private limited. 2017;7-15.

Enid GB, Raj PK, Luc LO, Joseph RS. Potter's Pathology of the Fetus,Infant and Child. 2nd Ed. Elsevier. 2007.

Moss W, Darmstadt GL, Marsh DR, Black RE, Santosham M. Research priorities for the reduction of perinatal and neonatal morbidity and mortality in developing country communities. J Perinatol Off J Calif Perinat Assoc. 2002;22(6):484-95.

Jaiman S. Performing a perinatal autopsy. J Fetal Med. 2015;2(3):101-11.

Sankar VH, Phadke SR. clinical utility of fetal autopsy and comparison with prenatal ultrasound findings. J Perinatol Off J Calif Perinat Assoc. 2006;26(4):224-9.

Pradhan R, Mondal S, Adhya S, Raychaudhuri G. perinatal autopsy: a study from india. J Indian Acad Forensic Med. 2013;35:10-3.

Mutz-dehbalaie I, Scheier M, Jerabek-Klestil S, Brantner C, Windbichler GH, Leitner H, et al. Perinatal mortality and advanced maternal age. Gynecol Obstet Invest. 2014;77(1):50-7.

Joseph KS, Allen AC, Dodds L, Turner La, Scott H, Liston R. The perinatal effects of delayed childbearing. Obstet Gynecol. 2005;105(6):1410-8.

Reddy UM, Ko C-W, Willinger M. maternal age and the risk of stillbirth throughout pregnancy in the united states. Am J Obstet Gynecol. 2006;195(3):764-70.

Unterscheider J, O’donoghue K, Daly S, Geary MP, Kennelly MM, Mcauliffe FM, et al. fetal growth restriction and the risk of perinatal mortality-case studies from the multicentre porto study. BMC Pregnancy Childbirth. 2014;14:63.

Getiye Y, Fantahun M. factors associated with perinatal mortality among public health deliveries in addis ababa, ethiopia, an unmatched case control study. BMC Pregnancy Childbirth. 2017;17(1):245.

Ravelli ACJ, Eskes M, Van der JAM, Abu-Hanna A, De Groot CJM. decreasing trend in preterm birth and perinatal mortality, do disparities also decline? BMC Public Health. 2020;20(1):783.

Brahmanandan M, Murukesan L, Nambisan B, Salmabeevi S. Risk factors for perinatal mortality: a case control study from Thiruvananthapuram, Kerala, India. Int J Reprod Contracept Obstet Gynecol. 2017;6(6):2452-8.

Allanson ER, Muller M, Pattinson RC. Causes of perinatal mortality and associated maternal complications in a south african province: challenges in predicting poor outcomes. BMC Pregnancy Childbirth. 2015;15:37.

Maghsoudlou S, Cnattingius S, Aarabi M, Montgomery SM, Semnani S, Stephansson O, et al. consanguineous marriage, prepregnancy maternal characteristics and stillbirth risk: a population-based case-control study. Acta Obstet Gynecol Scand. 2015;94(10):1095-101.

Draper ES, Kurinczuk JJ, Abrams KR, Clarke M. assessment of separate contributions to perinatal mortality of infertility history and treatment: a case-control analysis. Lancet Lond Engl. 1999;353(9166):1746-9.

Virgu R, Molla M, Sibley L, Gebremariam A. Perinatal mortality magnitude, determinants and causes in west gojam: population-based nested case-control study. Plos One. 2016;11(7):e0159390

Kalyani R, Bindra MS, Mahansetty H. Congenital malformations in perinatal autopsy: a two-year prospective study. J Indian Med Assoc. 2013;111(2):89-93.

Kale-jain PP, Kanetkar SR, Shukla DB, Hulwan AB, Borade P, Vohra NV. study of congenital malformations in fetal and early neonatal autopsies. Ann Pathol Lab Med. 2017;4(4):433-41.

Korteweg FJ, Erwich JJHM, Holm JP, Ravisé JM, Van der meer J, Veeger NJGM, et al. diverse placental pathologies as the main causes of fetal death. obstet gynecol. 2009;114(4):809-17.

Kidron D, Bernheim J, Aviram R. placental findings contributing to fetal death, a study of 120 stillbirths between 23 and 40 weeks gestation. Placenta. 2009;30(8):700-4.

Andola US, Am A, Ahuja M, Andola Sk. congenital malformations in perinatal autopsies - a study of 100 cases. J Clin Diagn Res JCDR. 2012;6(10):1726-30.

Menter T, Mertz KD, Jiang S, Chen H, Monod C, Tzankov A, et al. placental pathology findings during and after sars-cov-2 infection: features of villitis and malperfusion. Pathobiology. 2021;88(1):69-77.

Baergen RN, Heller DS. Placental pathology in covid-19 positive mothers: preliminary findings. Pediatr Dev Pathol Off J Soc Pediatr Pathol Paediatr Pathol Soc. 2020;23(3):177-80.