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Parameters for estimating the time of death at perinatal autopsy of stillborn fetuses: a systematic review

  • Mariano Paternoster
  • Mauro Perrino
  • Antonio TravaglinoEmail author
  • Antonio Raffone
  • Gabriele Saccone
  • Fulvio Zullo
  • Francesco Paolo D’Armiento
  • Claudio Buccelli
  • Massimo Niola
  • Maria D’Armiento
Review

Abstract

Background

Stillbirth is defined by the WHO as birth of a fetus with no vital signs, at or over 28 weeks of pregnancy age. The estimation of time of death in stillbirth appears crucial in forensic pathology. However, there are no validated methods for this purpose.

Objective

To perform a systematic review of the available literature regarding the estimation of the time of death in stillborn fetuses, in terms of hours or days.

Methods

Electronic databases were searched from their inception to August 2018 for relevant articles. Macroscopic, histologic, and radiologic parameters were evaluated.

Results

Nine studies with 664 stillborns were included. The evaluation of extent and location of fetal maceration signs showed good accuracy in estimating the time of death; by contrast, a dichotomous assessment of maceration (present vs absent) was found to be unreliable in a subsequent study. Histologic assessment of the loss of nuclear basophilia in fetal and placental tissues showed excellent accuracy; an “autolysis equation” was proposed to achieve an even higher accuracy in fetuses who had been dead for < 24 h. Magnetic resonance imaging of the lung parenchyma, pleural fluids, and brain parenchyma could estimate the death-to-autopsy time, but the results appeared weak and conflicting.

Conclusion

Pathologic examination, based on the assessment of maceration, and even more of the loss of nuclear basophilia, may be a reliable method to estimate the time of death in stillborn fetuses. Further studies should be encouraged to validate these results. Imaging techniques have not yet found application in this field.

Keywords

Stillbirth Intrauterine death Fetal death Autopsy Maceration Perinatal pathology 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Mariano Paternoster
    • 1
  • Mauro Perrino
    • 1
  • Antonio Travaglino
    • 2
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  • Antonio Raffone
    • 3
  • Gabriele Saccone
    • 3
  • Fulvio Zullo
    • 3
  • Francesco Paolo D’Armiento
    • 2
  • Claudio Buccelli
    • 1
  • Massimo Niola
    • 1
  • Maria D’Armiento
    • 4
  1. 1.Legal Medicine Unit, Department of Advanced Biomedical Sciences, School of MedicineUniversity of Naples Federico IINaplesItaly
  2. 2.Anatomic Pathology Unit, Department of Advanced Biomedical Sciences, School of MedicineUniversity of Naples Federico IINaplesItaly
  3. 3.Gynecology and Obstetrics Unit, Department of Neuroscience, Reproductive Sciences and Dentistry, School of MedicineUniversity of Naples Federico IINaplesItaly
  4. 4.Pathology Unit, Department of Public Health, School of MedicineUniversity of Naples Federico IINaplesItaly

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