Histologic Signs of Fetal Distress in Stillbirths

Dipakkumar Prajapati^*
*Correspondence: Dipakkumar Prajapati, Departements of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, USA, Email:

Keywords

Distress • Pregnancy • Stillbirth • Histological

Introduction

There is ongoing discussion about the aetiology of aberrant amniotic fluid staining and the clinical implications of this phenomenon. The green colouring of amniotic fluid staining, which is associated with the presence of meconium, is a frequent anomaly. Meconium is the fetus's thick, green-black intestinal excretion that builds up in the foetal colon over the course of gestation. It is mainly made up of water mixed with waste from the intestinal, urinary, and cutaneous systems as well as lanugo hair, fatty material from the vernix caseosa, and gastro-intestinal secretions.The notion linking meconium to hypoxia hasn't been completely disproved yet, but despite the lack of clinical and scientific evidence, the evaluation of the staining of amniotic fluid is still done in delivery rooms. Due to worries about foetal distress, the outcome of this screening frequently results in increased medical treatments [1].

Description

The non-Hispanic black race, nulliparity, advanced maternal age, obesity, preexisting diabetes, chronic hypertension, smoking, alcohol use, having a pregnancy through assisted reproductive technology, multiple gestation, male foetal sex, unmarried status, and prior obstetric history are the risk factors for stillbirth that are most common in developed countries. Many of these factors cannot be changed, despite the fact that some of them (like smoking) might. Due to the lack of standardised procedures for evaluating and categorising stillbirths as well as the declining autopsy rates, research on specific causes of stillbirth has been impeded. It may be challenging to pinpoint a precise cause for a stillbirth in any given situation. Even after a careful examination, a sizable fraction of stillbirths are still unaccounted for. Fetal autopsy, a physical and histologic examination, and other tests should be done to evaluate a stillbirth [2].

Stillbirth is typically defined as fetal death at or after 20 or 28 weeks of pregnancy, depending on the source. It results in a baby born without signs of life. A stillbirth can result in the feeling of guilt or grief in the mother. The term is in contrast to miscarriage, which is an early pregnancy loss, and Sudden Infant Death Syndrome, where the baby dies a short time after being born alive.Often the cause is unknown. Causes may include pregnancy complications such as pre-eclampsia and birth complications, problems with the placenta or umbilical cord, birth defects, infections such as malaria and syphilis, and poor health in the mother. Risk factors include a mother's age over 35, smoking, drug use, use of assisted reproductive technology, and first pregnancy. Stillbirth may be suspected when no fetal movement is felt. Confirmation is by ultrasound [3,4].

Worldwide prevention of most stillbirths is possible with improved health systems. Around half of stillbirths occur during childbirth, with this being more common in the developing than developed world. Otherwise, depending on how far along the pregnancy is, medications may be used to start labor or a type of surgery known as dilation and evacuation may be carried out. Following a stillbirth, people are at higher risk of another one; however, most subsequent pregnancies do not have similar problems. Depression, financial loss, and family breakdown are known complications.It is unknown how much time is needed for a fetus to die. Fetal behavior is consistent and a change in the fetus' movements or sleep-wake cycles can indicate fetal distress. A decrease or cessation in sensations of fetal activity may be an indication of fetal distress or death, though it is not entirely uncommon for a healthy fetus to exhibit such changes, particularly near the end of a pregnancy when there is considerably less space in the uterus than earlier in pregnancy for the fetus to move about. Still, medical examination, including a nonstress test, is recommended in the event of any type of any change in the strength or frequency of fetal movement, especially a complete cease; most midwives and obstetricians recommend the use of a kick chart to assist in detecting any changes. Fetal distress or death can be confirmed or ruled out via fetoscopy/doptone, ultrasound, and/or electronic fetal monitoring. If the fetus is alive but inactive, extra attention will be given to the placenta and umbilical cord during ultrasound examination to ensure that there is no compromise of oxygen and nutrient delivery [5].

Conclusion

Because labour typically starts on its own after two weeks and foetal death in pregnancy does not pose an urgent health concern to the pregnant woman, she may decide to wait and deliver the foetus' remains vaginally. Labor induction is advised at this point because the pregnant lady is at danger of having blood coagulation issues after two weeks. In many circumstances, the pregnant lady will decide to have labour induced because she finds the thought of carrying a deceased foetus distressing. It is not advised to have a caesarean section unless difficulties arise during vaginal delivery. Healthcare professionals' communication of the stillbirth diagnosis to parents may have a profound and long-lasting effect on them.

Preterm birth (PTB) has historically been listed as one of the causes when identifying the causes of infant death. However, preterm neonates also pass away from conditions other than PTBs like asphyxia, infection, and congenital anomalies, as well as from a number of complications related to prematurity, such as respiratory distress syndrome (RDS), necrotizing enterocolitis (NEC), and intraventricular haemorrhage (IVH). Infections, congenital defects, and a number of maternal and foetal disorders that result in suffocation, such as placental abruption, obstructed labour, preeclampsia, placental malfunction, and cord problems, are all factors in stillbirths. Due to birth asphyxia, the factors that cause foetal hypoxia also increase the risk of newborn mortality.

Acknowledgement

None.

Conflict of Interest

There are no conflicts of interest by author.

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