Institute of Legal Medicine, Department of Medical and Surgical Sciences, "Magna Graecia" University of Catanzaro.
Clin Ter. 2024 Jul-Aug;175(Suppl 2(4)):172-175. doi: 10.7417/CT.2024.5109.
Fetal death has various causes, among the most common are problems relating to the placenta, such as placental abruption or placental malformations such as placenta accreta. From the literature, it emerges that placental analysis at autopsy can allow for greater resolution of cases compared to clinical history and external examination of the fetus alone.
We report the case of a woman at the eleventh week of pregnancy who died in hospital. The medical history revealed two further previous pregnancies, both with births by cesarean section. The autopsy identified the cause of maternal death as acute cardiorespiratory arrest secondary to hemorrhagic shock from spontaneous uterine rupture. Hemorrhagic infiltrate was found in the intervillous placental spaces with rupture of the uterus due to placenta previa and accreta.
Placenta accreta is a condition in which a pathological adherence and/or invasion of the myometrium by the placenta is observed. This condition poses a problem during recovery with potential for severe bleeding. Therefore, we emphasize the macroscopic and histological analysis of the placenta, uterus and the ovaries in all cases of maternal-fetal death, suggesting however that the organs be analyzed both by gross analysis and after permanence in formaldehyde. Furthermore, in these cases, it is important to evaluate the clinical history and data, especially ultrasound scans performed in life, or insertion anomalies during instrumental investigations. For this reason, we recommend to collaborate with a multidisciplinary team in these cases, including the gynecologist and the forensic pathologist.
胎儿死亡有多种原因，最常见的是与胎盘有关的问题，如胎盘早剥或胎盘畸形，如胎盘植入。从文献中可以看出，与仅根据临床病史和胎儿外部检查相比，尸检时对胎盘进行分析可以更准确地确定病例。
我们报告了一名怀孕第 11 周的妇女在医院死亡的病例。该病史显示，她之前还有两次妊娠，均通过剖宫产分娩。尸检确定了母亲死亡的原因是由于自发性子宫破裂引起的出血性休克导致急性心肺骤停。由于前置胎盘和胎盘植入，胎盘绒毛间隙可见出血性浸润，子宫破裂。
胎盘植入是指胎盘异常黏附或侵入子宫肌层的一种情况。这种情况在恢复过程中会导致严重出血，因此存在问题。因此，我们强调在所有母婴死亡病例中都要对胎盘、子宫和卵巢进行宏观和组织学分析，但建议在所有情况下，不仅要通过大体分析，还要在福尔马林固定后对器官进行分析。此外，在这些情况下，评估临床病史和数据（尤其是生前进行的超声检查或器械检查时的插入异常）非常重要。因此，我们建议在这些情况下与多学科团队合作，包括妇科医生和法医病理学家。
