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Forensic Toxicology

, Volume 36, Issue 2, pp 514–524 | Cite as

Toxicological and histological analyses for a stillborn delivered by a mother under methadone maintenance therapy

  • Eva Montanari
  • Maria Paola Bonasoni
  • Manuela Licata
  • Alberto Salomone
  • Enrico Gerace
  • Marco Vivarelli
  • Raffaele Giorgetti
  • Adriano Tagliabracci
Case Report

Abstract

Purpose

Based on autopsy findings and toxicological results, it was ascertained whether chronic fetal exposure to methadone (MTD) could have caused intrauterine death of a fetus born to a mother under MTD maintenance therapy.

Methods

Complete fetal autopsy, placental examination and toxicological and histological analyses were performed on a 39-week-old stillborn fetus, whose mother had regularly taken MTD during the pregnancy. The MTD and its main metabolite 2-ethylidene-1,5-dimethyl-3,3-diphenylpyrrolidine (EDDP) were quantified in fetal tissues (brain, liver and kidney) by ultra-high-performance liquid chromatography–tandem mass spectrometry. A fully validated toxicological analytical method was developed.

Results

High levels of MTD and EDDP were present in all samples. The EDDP-to-MTD ratios were similar in the liver and kidney, but in the brain, MTD was predominant. Placental histology showed a thrombotic partially organised lesion in the first branches of the umbilical vein (chorionic venous vessels) and delayed villous maturation (DVM) diffusely found in the parenchyma.

Conclusions

High levels of MTD and EDDP correlated with chronic fetal exposure to MTD maintenance therapy in pregnancy. Placenta DVM can be associated with the MTD exposure, indirectly affecting glycaemic balance. Fetal cause of death seemed to be related to a global hypoxic-ischemic status as a combination of chronic fetal MTD intoxication, placental DVM and impaired placenta blood flow due to chorionic thrombosis.

Keywords

Methadone EDDP Human fetus Placenta Stillborn Histopathology 

Notes

Compliance with ethical standards

Conflict of interest

The authors have no financial or other relations that could lead to a conflict of interest.

Ethical approval

In Italy, there is no legislation that forbids the use of human tissues collected during an autopsy, provided that the samples are made anonymous and linked exclusively to codes.

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Copyright information

© Japanese Association of Forensic Toxicology and Springer Japan KK, part of Springer Nature 2018

Authors and Affiliations

  • Eva Montanari
    • 1
  • Maria Paola Bonasoni
    • 2
  • Manuela Licata
    • 3
  • Alberto Salomone
    • 4
  • Enrico Gerace
    • 4
  • Marco Vivarelli
    • 5
  • Raffaele Giorgetti
    • 1
  • Adriano Tagliabracci
    • 1
  1. 1.Section of Legal MedicineUniversità Politecnica delle MarcheAnconaItaly
  2. 2.Pathology Unit, Azienda Unità Sanitaria LocaleIRCCSReggio EmiliaItaly
  3. 3.Forensic Toxicology Laboratory, Department of Diagnostic Clinical and Public Health MedicineUniversità di Modena and Reggio EmiliaModenaItaly
  4. 4.Regional Antidoping Centre, “A. Bertinaria”TurinItaly
  5. 5.Department of Experimental and Clinical Medicine, Hepatobiliary and Abdominal Transplantation SurgeryUniversità Politecnica delle MarcheAnconaItaly

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