SYNOPSIS

Rajiv Gandhi University of Health Sciences, Bangalore , Karnataka .

“CORRELATIVE STUDY OF FETAL AUTOPSY WITH ULTRASONOGRAPHIC FINDINGS”

Name of the candidate : Dr. Raj Kumari Robina Devi

Guide : Dr. Muktha R. Pai

Course and Subject : M.D. (Pathology)

Department of Pathology,

A J Institute of Medical Sciences,

Kuntikana, Mangalore.

2013

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE, KARNATAKA.

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1 / Name of the candidate and address (in block letters) / DR RAJ KUMARI ROBINA DEVI,
POST GRADUATE RESIDENT,(MD)
DEPARTMENT OF PATHOLOGY,
A J INSTITUE OF MEDICAL SCIENCES,
MANGALORE.
2 / Name of the Institution / A J INSTITUTE OF MEDICAL SCIENCES MANGALORE.
3 / Course of study and Subject / MD PATHOLOGY.
4 / Date of admission to course / 05/07/2013
5 / Title of the Topic
“CORRELATIVE STUDY OF FETAL AUTOPSY WITH ULTRASONOGRAPHIC FINDINGS”.
6 / BRIEF RESUME OF THE INTENDED WORK:
6.1 Need for the study
In industrialized countries, malformations are the first cause of prenatal death (25-30%) and are related to an elevated morbidity in the neonatal and post- natal period [1]. Routine anomaly scan during antenatal period has become a part of obstetric care and the best time for fetal malformation scan is at around 18-20 weeks. Even though ultra sonogram can give fairly accurate diagnosis, examination of the terminated fetus for associated anomalies is essential to confirm the diagnosis and look for associated malformation. This is necessary because some associated malformations can be missed or are undetectable on ultrasound [2].
The primary reason for studying the dead is to save the living to correlate the events that have transpired during life with the state of the body after death and to come to such conclusion as to the cause and effect. Autopsy, therefore is an important tool not only to detect the cause of death but also to elicit whether such death is preventable.
6.2 Review of Literature
Congenital malformation remain a common cause of perinatal deaths and account for 25-30% in developed countries and (10-15%) in developing countries like India [2].
Spanish gynecology and obstetrics association (SEGO) recommends that an ultrasound scan be carried out at around the 20thweek of both low and high-risk pregnancies. In this ultrasound scan, fetal morphology, and the placenta, number of vessels in the cord, quantity of amniotic fluid is examined. The abnormality in the number of cord vessels is not considered a minor ultrasound marker by the (SEGO) [3].
In addition, monogenic inheritance (e.g some case hydrocephalus) and in certain cases, intrauterine infection (e.g Toxo plasma gondii) can be found among the cause. Certain craniofacial malformation (Neural tube defect) could be diagnosed as early as the dawn of ultrasonography and this group of malformation has been the focus of attention ever since. It can be attributed to its relatively high incidence and rather poor prognosis in the majority of cases [4].
In the year 2007 to 2008, intrauterine fetal demise, has been diagnosed with gestational age of 20weeks or more in women attending clinic at Lady Goschen hospital. 28 women were included in the study and fetal autopsy was conducted. Preeclampsia was the commonest with intrauterine fetal death in 14.28% followed by diabetes mellitus in 10.7% and oligohydraminios in 7.14%. Among the women in whom autopsy showed a fetal anomaly, ultrasound was found to detect the same in 55.55% [5].
In a study done in 2000 to 2003, 42 cases of single umbilical artery were diagnosed among a total of 5987 patients, scanned at around the 20th week of pregnancies, thus representing a prevalence of 0.7% [3].
In a study done in U.S.A, it was concluded that antenatal sonographic and corresponding autopsy findings of an extremely rare association of classic pentalogy of Cantrell with exencephaly and myelomeningocele [6].
During the study done in India 70 perinatal autopsies were performed and analyzed critically. Out of all (i.e.70) perinatal deaths, 66 cases (94.3%) were low birth weight babies & only 4(5.7%) were of normal birth weight. Gross and microscopic examination of placenta & umbilical cord shows that abnormality was detected in only in 12 (17.14%) cases out of 70 cases. Most of the babies, (88.57%) were still born and only 8 (11.43%) died in Neonatal period [7].
6.3 Objectives of the study
1. To evaluate the clinical utility of perinatal autopsy in determining the cause of death and type of anomaly and confirming the findings of ultrasonography.
2. To conduct a histopathologic evaluation of tissues obtained at fetal autopsy and to confirm the autopsy findings wherever indicated.
7. / Material and methods:
7.1 Source of data.
The data collection period of the study will be 2 years retrospective(2011,2012)and prospective from July 2013 to May 2015.The study material will be dead fetuses received in the department of pathology expelled or terminated due to intrauterine death, stillbirth or fetal malformation. The specimens are received from the hospital attached to A.J institute of medical sciences. A minimum of 50 specimens will be included in the study.
7.2 Method of collection of data.
Consent is obtained either from parents or guardian after explaining the procedure in their vernacular language. Fetuses will be fixed by injecting 10% buffered formalin into the body cavities and fixed for 24 to 48 hours. A detailed gross examination will be performed after fixation is complete. The body measurements which includes (The crown rump length, rump heel length, circumferences of the head, chest, foot length and abdomen will be noted). The external examination of the body will be carefully inspected for the evidence of any malformation or abnormalities (e.g. face, eye, nose, buccal cavity, tongue, palate, gum, general appearance of ear are noted) and color of skin, nipples, hair growth also noted to assess the maturity of the fetus.
Initial incision are given in the body cavities from symphysis menti to the symphysis pubis (The abdominal viscera were examined first then chest wall are opened and all the viscera are removed by Rokitanksy technique in a single block). Histological sections are taken from lung, liver, kidney, thymus, costocondral junction of rib, brain, placentae (if sent), fetal membranes and umbilical cord.
Inclusion criteria:
1)  All fetus of the gestational age completed 18 -20weeks of life.
Exclusion criteria:
1)  All autolysed fetuses.
2)  All fetuses of gestational age less than 18 weeks of life.
Plan for data analysis:
The obtained parameters will be evaluated using description statistical analysis and any other statistical formulae will be applied as and when required.
Informed consent: Informed consent is taken from the parents and the fetus specimen is send to the department of pathology (Hospital attached to A.J institute of medical sciences).
7.3 Does the study require any investigations or interventions to be conducted on patients or other humans or animals? If so, please describe briefly? – No.
7.4 Has ethical clearance been obtained from your institution:
Applied for ethical committee clearance.
8 / LIST OF REFERENCES
1.Vimercati A, Grasso S, Abruzzese M et al. Correlation between ultrasound diagnosis and autopsy findings of diagnosis and autopsy findings of fetal malformations. J. Perinat. Med.2012; 6 (2):13-17.
2. Sankar VH, Phadke SR. Clinical utility of fetal autopsy and comparison with prenatal ultrasound findings. J. perinatol. 2006; 26:224-9.
3. Payo CM, Gaitero A, Tamarit I, Espantaleon MG, Goy EI.Perinatal results following the prenatal ultrasound diagnosis of single umbilical artery.Acta obstet Gynecol scand 2005 April;84:1068-74.
4. Joó JG, Beke A, Szigeti Z et al. Craniospinal malformations in a twelve-year fetopathological study; the efficiency of ultrasonography in view off fetopathological investigations. Early Hum Dev.2007 March; 1-5.
5. Nayak SR, Nidhi G. Determination of ante partum fetal death. J obstet Gynecol India.2010November/December; 60(6):494-97.
6. Kachare MB, Palki VK, Saboo Sonali S, Saboo SH, Ahlawat K, Saboo Sachin S. Pentalogy of Cantrell associated with exencephaly and spinal dysraphism: antenatal ultrasonographic diagnosis. Case report. Med ultrason 2013 May; 15 (3):237-39.
7. Pradhan R, Mondal S,Adhya S, Raychaudhuri G. Perinatal autopsy: A study from India. J Indian Acad forensic Med.2013; 35 (1):10-13.
9 / Signature of candidate
10 / Remarks of the guide / .
11 / Name & Designation of
(in block letters)
11.1 Guide
11.2 Signature / Dr. Muktha R.Pai M.B.B.S, MD.,
PROFESSOR ,
A J INSTITUTE OF MEDICAL SCIENCES,
MANGALORE.
11.3 Head of Department
11.4 Signature / Dr. UMARU N. M.B.B.S, MD.,
PROFESSOR AND HOD,
A J INSTITUTE OF MEDICAL SCIENCES,
MANGALORE
12 / 12.1 Remarks of the
Chairman and Principal
12.2 Signature
PROFORMA
POST MORTEM NO:
HISTOPATHOLOGY NO:
MATERNAL CHARACTERISTICS:
NAME:
AGE:
HOSPITAL: HOSPITAL NO:
ANY ASSOCIATED DISEASE IN THE MOTHER:
ANTENATAL HISTORY:
USG REPORT:
PLACENTAL CHARACTERISTICS:
MEASUREMENTS:
LENGTH OF THE ATTACHED UMBILICAL CORD:
UMBILICAL VESSELS:
ATTACHMENT OF THE CORD:
GROSS EXAMINATION OF THE MEMBRANES:
GROSS EXAMINATION OF THE COTYLEDONES:
MICROSCOPIC FEATURES:
FETAL CHARACTERISTICS:
GENDER OF THE FETUS:
WEIGHT OF THE FETUS:
GESTATIONAL AGE:
MEASUREMENTS:
HEAD CIRCUMFERENCE: FOOT LENGTH:
CHEST CIRCUMFERENCE: ABDOMINAL GIRTH:
CROWN RUMP LENGTH: RUMP HEEL LENGTH:
EXTERNAL EXAMINATION:
HEAD AND SKULL:
SKIN:
EYES,EARS,NOSE,MOUTH:
EYEBROWS:
NAILS:
ANUS
NIPPLES
EXTERNAL GENITALIA:
GROSS EXAMINATION
CENTRAL NERVOUS SYSTEM:
CARDIOVASCULAR SYSTEM:
RESPIRATORY SYSTEM:
GASTROINTESTINAL SYSTEM:
LIVER AND GALL BLADDER:
GENITOURINARY SYSTEM:
MICROSCOPY:
IMPRESSION:
A.J Hospital and research centre kuntikana,mangalore-575004.
Consent form
I, ______daughter/wife/husband………………………………aged about ………………………years residing at …………………………………………………..de hereby give my consent for the autopsy to be done on the dead fetus obtained after expelling/stillbirth.
Place
Date Signature of the parents

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