Histologic Estimation of Intrauterine Retention Time after Fetal Death

Jang Han Kim

doi:10.7580/kjlm.2013.37.4.191

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Kim: Histologic Estimation of Intrauterine Retention Time after Fetal Death

Original Article

Korean J Leg Med 2013;37(4):191-197.

Published online: 17 January 2013

DOI: https://doi.org/10.7580/kjlm.2013.37.4.191

Histologic Estimation of Intrauterine Retention Time after Fetal Death

Jang Han Kim

Department of Medical Humanities and Social Sciences, University of Ulsan College of Medicine, Seoul, Korea

Corresponding Author : Jang Han Kim, Department of Medical Humanities and Social Sciences, University of Ulsan College of Medicine, 86 Asanbyeongwon-gil Songpa-gu, Seoul 138-736, Korea. TEL : +82-2-3010-4266 FAX : +82-2-477-4266 E-mail : jhk@amc.seoul.kr

Received 11 October 2013 Revised 6 November 2013 Accepted 11 November 2013

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Key Words, Autolysis, Basophilia, Death, Fetus, Histology

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).

Fig. 2.

Autolysis curve derived from fetal rats. Percentile Score (PS) shows a steep downward slope after 24 hours immersion time (IT).

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).

Table 1.

Loss of Nuclear Basophilia from Rat Fetal Tissues

IT∗ (hour)	Kidney				Heart	Lung	Liver	GI^†	GI^†	PS^§%
IT∗ (hour)	p^‖	d^¶	c^∗∗	g^††	Heart	Lung	Liver	GI^†	GI^†	PS^§%
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^∗∗	Heart	B^††	T^††	Liver	Pe^§§	Fe^‖‖	Thymus	PS^§(%)
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.

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