Third trimester intrauterine fetal death: proposal for the assessment of the chronology of umbilical cord and placental thrombosis

The timing of umbilical cord and placental thrombosis in the third trimester intrauterine fetal death (TT-IUFD) may be fundamental for medico-legal purposes, when it undergoes medical litigation due to the absence of risk factors. Authors apply to human TT-IUFD cases a protocol, which includes histo...

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Bibliographic Details
Published in:International journal of legal medicine 2022-05, Vol.136 (3), p.705-711
Main Authors: Bonasoni, Maria Paola, Muciaccia, Barbara, Pelligra, Caterina B., Goldoni, Matteo, Cecchi, Rossana
Format: Article
Language:English
Subjects:
Age
Angiogenesis
Autopsies
Blood clots
Blood vessels
Calcium
Chronology
Death
Female
Fetal Death - etiology
Forensic Medicine
Histochemistry
Humans
Legal medicine
Litigation
Macrophages
Medical Law
Medicine
Medicine & Public Health
Original
Original Article
Parameters
Placenta - pathology
Pregnancy
Pregnancy Trimester, Third
Regression models
Risk analysis
Risk factors
Stillbirth
Thrombosis
Thrombosis - pathology
Umbilical cord
Umbilical Cord - blood supply
Umbilical Cord - pathology
Veins
Veins & arteries
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Summary:The timing of umbilical cord and placental thrombosis in the third trimester intrauterine fetal death (TT-IUFD) may be fundamental for medico-legal purposes, when it undergoes medical litigation due to the absence of risk factors. Authors apply to human TT-IUFD cases a protocol, which includes histochemistry and immunohistochemistry (IHC) for the assessment of thrombi’s chronology. A total of 35 thrombi of umbilical cord and/or placenta were assessed: 2 in umbilical artery, 6 in umbilical vein, 15 in insertion, 10 in chorionic vessels, 1 in fetal renal vein, 1 in fetal brachiocephalic vein. Thrombi’s features were evaluated with hematoxylin–eosin, Picro-Mallory, Von Kossa, Perls, and immunohistochemistry for CD15, CD68, CD31, CD61, and Smooth Muscle Actin. The estimation of the age of the thrombi was established by applying neutrophils/macrophages ratio taking into consideration, according to literature, the presence of hemosiderophagi, calcium deposition, and angiogenesis. To estimate an approximate age of fresh thrombi (
ISSN:0937-9827
1437-1596
DOI:10.1007/s00414-022-02784-3