Estimating the time of death in stillborn fetuses: II. Histologic evaluation of the placenta; a study of 71 stillborns.

OBJECTIVE

To determine whether placental histologic examination is useful for predicting the approximate time of death in stillborn fetuses.

METHODS

Hematoxylin and eosin slides of 71 placentas of stillborns with accurately timed deaths were studied retrospectively. Fifty-one placentas (learning set) were used to develop proposed histologic criteria for the timing of fetal death, which were then tested in the remaining 20 placentas (test set).

RESULTS

Among 15 histologic variables assessed in the learning set, three features appeared to correlate well with specific death-to-delivery intervals: 1) villous intravascular karyorrhexis (6 or more hours); 2) vascular lumen abnormalities of stem villi, including fibroblast "septation" and total luminal obliteration (multifocal, 2 or more days; extensive, 2 or more weeks); and 3) extensive fibrosis of terminal villi (2 or more weeks). When the placentas in the test set were evaluated using the three histologic criteria, 18 of 20 cases were classified correctly with respect to the approximate time of fetal death.

CONCLUSIONS

Placental histologic examination seems to be useful for determining the approximate time of death in many stillborn fetuses.