Fetal sepsis: a cause of stillbirth

Abstract

Infection is considered a leading cause of fetal death, responsible for approximately 20% of cases. Such estimates are derived from the frequency of acute histological chorioamnionitis and funisitis in cases of fetal death rather than direct detection of microorganisms in the fetal compartment. We report a case of clinically unexplained fetal death at 38 weeks of gestation in an uncomplicated pregnancy resulting in delivery of an appropriate-for-gestational-age fetus. The mother did not have any clinical signs of infection. Overwhelming bacterial invasion in multiple fetal organs, including the heart, liver, spleen, and kidneys, was observed despite the lack of evidence of maternal clinical infection. The bacteria were visualized by using standard histologic techniques (e.g. H&E/ tissue Gram stain) highlighting the value of autopsy in determining the cause of death.

Keywords:

• Bacteria
• chorioamnionitis
• fetal autopsy
• fetal cytokine storm
• fetal death
• fetal inflammatory response syndrome
• funisitis
• pathology
• placenta
• pregnancy

Acknowledgements

The authors are grateful for the editorial support provided by Maureen McGerty, MA (Wayne State University). The author (SJ) expresses personal gratitude to Dr. Pramod G, Dr. Tejopratap, and Dr. Asha from the Fernandez Foundation for their support. The author (SJ) also acknowledges the help of Mr. Mallesh, Mr. Suresh and Ms. Tasneem.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This article was supported, in part, by the Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services [NICHD/NIH/DHHS]; and, in part, with Federal funds from NICHD/NIH/DHHS under Contract No. HHSN275201300006C. Dr. Romero has contributed to this work as part of his official duties as an employee of the United States Federal Government.