Intrauterine Demise, Perinatal and Iatrogenic Problems
Core concepts
Approach stillbirth systematically: maternal history, placental examination, autopsy, karyotype/microarray, and infection workup. Understand mechanisms of fetal death-placental insufficiency, cord accidents, infection, hemorrhage (fetomaternal), chromosomal anomalies, and maternal disease. Know the timing markers of fetal demise on autopsy (maceration, skin changes, radiologic findings) and how postmortem interval affects interpretation.
Perinatal problems to master: respiratory distress syndrome (surfactant deficiency, hyaline membranes), bronchopulmonary dysplasia, necrotizing enterocolitis, intraventricular hemorrhage in prematurity, and hypoxic-ischemic encephalopathy. Iatrogenic issues include ventilator-induced lung injury, catheter complications, and transfusion-related problems in neonates.
Traps
Questions conflate antepartum vs intrapartum demise and their differing autopsy findings. Another trap: over-interpreting maceration as a specific cause-it is a timing marker. Do not assume a normal karyotype excludes genetic disease; microarray adds yield. In NEC, remember that it is multifactorial and not simply infection.
Worked example / rule of thumb
A macerated stillborn with growth restriction and a small, infarcted placenta: prioritize placental insufficiency. Rule of thumb: "Stillbirth workup = placenta + autopsy + genetics + infection," and always examine the cord and membranes.