Journal List > Korean J Leg Med > v.37(4) > 1004713

Kim: Histologic Estimation of Intrauterine Retention Time after Fetal Death

Abstract

The intrauterine retention time (IURT) after fetal death can be estimated from the loss of nuclear basophilia. We therefore attempted to derive an autolysis equation to estimate IURT in experimental rat fetuses and human fetal autopsy slides. The degree of loss of nuclear basophilia in various tissues was assessed by hematoxylin and eosin (H & E) staining. Fetal rat tissues showed different rates of autolysis, allowing for the construction of an experimental autolysis curve. We also reviewed the H & E stained slides obtained from 27 human fetal autopsy cases with well-documented death intervals. The degree of autolysis in various tissues was evaluated using percentile scores (PS). Using the findings from H&E staining, we derived the equation Ln (PS/[100-PS]) = 2.62716-0.02377 × IURT. However, this equation or autolysis scores showed some limitations. Owing to the inconsistency of PS, this equation is reliably applicable only within 24 hours of intrauterine fetal death. In the fetal autopsy review, fetal hydrops, local effusion, and sepsis also contributed to accelerated autolysis.

REFERENCES

1. Shanklin DR. Fetal maceration. 2. An analysis of 53 human stillborn infants. Am J Obstet Gynecol. 1964; 88:224–9.
2. Babala J. Practical significance and various new aspects arising from the pathological-anatomical analysis of intrauterine dead fetuses. Bratisl Lek Listy. 1970; 54:210–5.
3. Genest DR, Williams MA, Greene MF. Estimating the time of death in stillborn fetuses: I. Histologic evaluation of fetal organs; an autopsy study of 150 stillborns. Obstet Gynecol. 1992; 80:575–84.
4. Langman J. Medical embryology. Baltimore: Williams & Wilkins;1981. 351.
5. Dillman RC, Dennis SM. Sequential sterile autolysis in the ovine fetus: microscopic changes. Am J Vet Res. 1979; 40:321–5.

Fig. 1.
The loss of nuclear basophilia was assessed according to the Genest's criteria: a) Kidney proximal tubules (arrow, PS = 100) and distal tubules (double line arrow, PS = 100) (H & E, ×400). b) Kidney collecting tubule (arrow, PS = 50, double line arrow, PS = 0) (H & E, ×400). c) Heart cardiac myocytes show (PS = 100), (H & E, ×400). d) Cardiac myocytes (PS = 50), (H & E, ×200). e) Bronchial epithelium shows (PS = 100), (H & E, × 400). f) Bronchial epithelium shows (PS = 50), (H & E, ×400). g) Bronchial cartilage (PS = 100), (H & E, ×400). h) Bronchial chondrocytes (PS = 50), (H & E, ×400). i) Outer fetal zone of adrenal gland shows (arrow, PS = 100) and inner permanent zone (double line arrow) shows (arrow, PS = 50), (H & E, ×200). j) Hepatocytes (arrow, PS = 100) (arrow) and hematopoietic cells (double line arrow), (H & E, ×400). k) Hepatocytes (PS = 50), (H & E, ×400). l) Leukocyte common antigen staining of thymocytes shows (PS = 100), (H & E, ×400) (PS, percentile score).
kjlm-37-191f1.tif
Fig. 2.
Autolysis curve derived from fetal rats. Percentile Score (PS) shows a steep downward slope after 24 hours immersion time (IT).
kjlm-37-191f2.tif
Fig. 3.
IURT derived from the percentile score (PS) of H & E. Ln(PS/(100-PS)) = 2.62716 - 0.02377 × IURT, which is shown in the middle line. The other lines represent the upper and lower limits of Intrauterine Retention Time (IURT).
kjlm-37-191f3.tif
Table 1.
Loss of Nuclear Basophilia from Rat Fetal Tissues
IT∗ (hour) Kidney Heart Lung Liver GI GI PS§%
p d c∗∗ g††
0 2 2 2 2 2 2 2 2   100.00
2 1 2 2 2 2 2 2 2   93.45
4 1 2 2 2 2 2 2 2   93.45
8 1 2 2 2 2 2 2 2   93.45
12 1 2 2 2 2 2 2 2   93.45
24 1 2 2 2 2 2 2 2   93.45
48 1 2 2 2 1 2 1 2   81.25
72 1 1 2 2 1 2 1 1 0 68.75
96 0 1 1 2 1 1 0 1 0 43.75
120 0 1 1 1 1 1 0 1 0 37.50
144 0 0 1 1 1 1 0 1   31.25
168 n n n n n n n n    

IT: Immersion time;

GI: Gastrointestinal tract;

GI: Gastrointestinal tract after exposure to saline;

§ PS: Percentile score;

p: Proximal tubule;

d: Distal tubule; ∗∗c: Collecting tubule;

†† g: Glomerulus;

†† n: Not evaluable

Table 2.
Loss of Nuclear Basophila from Human Fetal Tissues
IURT GA Wt Kidney Heart Lung Liver Adrenal Thymus PS§(%)
(hour) (day) (gram) P D C∗∗ B†† T†† Pe§§ Fe‖‖
0.3 153 440 2 2 2 2 2 2 2 2 2 n 100.00
0.5 155 293 1 2 2 2 2 2 2 2 2 2 95.00
1 164 670 2 2 2 2 2 2 2 2 2 2 100.00
1 189 920 2 2 2 2 2 2 2 1 1 2 90.00
1 243 1550 1 2 2 2 2 2 2 2 2 n 94.44
1 169 500 1 2 2 n¶¶ n n 2 2 2 2 92.85
1.5 154 560 1 2 2 2 2 2 2 2 2 2 95.00
1.5 154 555 1 2 2 2 2 2 2 2 2 2 95.00
1.63 171 684 1 2 2 2 2 2 2 2 2 n 94.44
1.63 159 439 2 2 2 2 2 2 2 2 1 n 94.44
1.75 159 459 1 2 2 2 2 2 1 2 1 n 83.33
6 281 3050 1 2 2 2 2 2 2 2 1 2 90.00
7 158 690 1 2 2 2 2 2 2 2 1 2 90.00
17.5 203 1900 1 1 2 1 2 2 2 2 1 1 75.00
24 272 3500 1 1 2 1 2 2 2 2 1 n 77.78
48 261 2000 0 1 2 0 2 2 1 0 0 1 45.00
60 184 1000 0 1 2 n 2 2 1 1 1 1 61.11
72 200 920 0 1 1 n 0 2 0 0 0 1 27.78
96 198 330 0 1 2 1 2 2 n n n n 66.67
120 282 2950 0 1 1 0 1 2 1 2 1 2 55.56
132 237 1070 0 1 2 n 0 0 0 n n 1 28.57
144 221 880 0 1 1 0 0 0 0 0 0 n 11.11
144 166 360 0 1 2 1 1 1 1 n n 1 50.00
156 190 650 0 1 2 1 2 2 0 1 1 2 60.00
180 262 2790 0 0 0 0 1 2 0 0 0 1 20.00
180 277 2890 n n n n 2 2 0 n n n 66.67
240 269 3860 0 0 0 0 0 0 0 0 0 0 0.00

IURT: Intrauterine retention time;

GA: Gestational age;

Wt: Weight;

§ PS: Percentile score;

P: Proximal tubule;

D: Distal tubule; ∗∗C: Collecting tubule;

†† B: Bronchial epithelium;

†† T: Tracheal cartilage;

§§ Pe: Permanent zone;

‖‖ Fe: Fetal zone;

¶¶ n: Not evaluable.

TOOLS
Similar articles