Impact of the delay between fetal death and delivery on the success of postmortem ultrasound following termination of pregnancy

Abstract

Objective

To evaluate the impact of the delay between fetal death and delivery on the nondiagnostic rates of post-mortem ultrasound (PM-US), following the termination of pregnancy (TOP).

Methods

We reviewed 204 cases of fetal two-dimensional PM-US performed in our center as part of a post-mortem imaging research program, over the last 5 years. Informed consent was obtained from the parents for all cases. PM-US was performed and reported according to a prespecified template with operators blinded to the prenatal diagnosis. In order to calculate the precise delay between the fetal death and the delivery, we included 107 fetal TOP’s ≥ 20 weeks of gestational age (GA), where feticide was performed using an injection of lidocaine 2% prior to induction of labor. Logistic regression analysis was conducted to analyze the impact of delay between fetal death and delivery (in hours), the GA at TOP (in weeks) and the method of feticide (intracardiac versus intraumbilical injection) on the PMUS nondiagnostic rates.

Results

The delay between fetal death and delivery increased the nondiagnostic rate of PM-US for cerebral examinations (OR: 1.04, IC 95%: 1.01–1.08, p < .05). For PM-US cardiac examination, the delay did not influence the nondiagnostic rate. However, GA (OR: 1.25, IC 95%: 1.10–1.46, p < .01) and feticide with intracardiac injection (OR: 4.29, IC 95%: 1.68–12.02, p < .01) were associated with higher nondiagnostic rates. For noncardiac thoracic and abdominal examinations, none of the studied variables influenced the nondiagnostic rate.

Conclusion

The success rate of cerebral PM-US was influenced by the delay between fetal death and delivery, suggesting a possible advantage of performing the feticide closer to the delivery where the examination of the brain is planned. For cardiac abnormalities, feticide by intraumbilical, rather than intracardiac injection improves diagnostic rates of cardiac PM-US.

Keywords:

• Postmortem
• postmortem-ultrasound
• termination of pregnancy
• virtual autopsy
• maceration

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

The Fetal Medicine Foundation Belgium partly funded this study, but had no role in study design, data gathering, data analysis, data interpretation, or writing of the report.