Perinatal pathology Flashcards
What is the definiton of miscarriage? [1]
What is the definiton of stillbirth? [1]
What is early and late neonatal death? [2]
What is infant death? [1]
Miscarriage: pregnancy loss <24 weeks
Stillbirth: baby born >24 weeks with no signs of life
Neonatal death: baby born live but dies in first 28 days of life
- Early neonatal: 0-7 days death
- Late neonatal: 7-28 days death
Infant death: anytime in first year
When do most of the 3500 deaths in children in the UK occur? [1]
< 4 weeks (but mainly the first day)
WHO recommends at least [] antenatal visits to reduce 8 in every 1000 births
WHO recommends at least 8 antenatal visits
What are biggest global causes of neonate death? [3]
What are biggest global causes of stillbirths? [3]
Neonates:
* Preterm
* Infections
* Birth complications (e.g. birth ashpyxia /
Still births:
* Malaria
* syphilis
* Diabetes & obesity
Name 8 causes of neonatal and infant death
Complications of prematurity
Complications of delivery: e.g. birth asphyxia
Congenital malformations, chromosomal abnormalities” known (antenatal diagnosis), unknown (SUDI)
Infection (SUDI, SUDC)
Accidents: e.g. drowning, suffocation, foreign body aspiration
Trauma: Road Traffic Accidents (SUDI, SUDC)
Non-accidental injury (NAI): inflicted injury
Unexplained deaths : SIDS
What are steps for a perinatal post mortem exam? [6]
- Clinical history and circumstance of death
- Radiology (XR)
- Check identification
- Body weight and measurements (IUGR)
- External signs of injury (skin lacerations / bruises / torn frenula / perineum and anus)
- External signs of disease (Dysmorphism and deformities rashes / oedema / jaundice)
Most common cause of deaths in newborns is []
Infections: Pneumonia 1st, RSV 2nd
Which ancillary investigations would you conduct in a post-mortem exam? [4]
Bacteriology
Virology
Toxicology
Metabolic and genetic studies
Ancillary investigations: which metabolic and genetic studies would you conduct if perinatal death has occured [4]
Vitreous humor (slow turn over – so stores problems)
Guthrie card: blood and bile spots
Skin for fibroblast culture
Frozen tissue: muscle, heart, liver, kidney for oil-red-O, to assess for abnormal fat accumulation
What internal examinations would you conduct in post-moretm?
Sampling: blood, fluids, tissue samples,
- Organ examination (weigh & exam); tissues samples from all organs
- Open skull: remove and weigh the brain (fix in formalin for 1-2 weeks prior to dissection & sampling)
What is SUDI? [1]
SUDI = sudden unexplained death in infancy
How does respiratory syncytial virus cause infant death? [1]
How does this appear histologically? [2]
RSV accounts for many cases of pneumonia in children under 2
Histologically:
* giant cells / macrophages with intracytoplasmic inclusion
* massive infiltrate of lymphoid cells in walls of bronchi causing obstruction
Mother delivers which immunoglobulin across the placenta? [1]
IgG
Which viruses is hand, foot and mouth disease commonly caused by? [3]
Describe pathology
Enterovirus 71 Virus
Coxsackie virus
Kawasaki virus
Causes neurological or cardiac complications including death
Kawasaki disease causes medium vessel vasculitis of children that can cause coronary artery aneursym
Explain pathophysiology of Marfans syndrome causing sudden death (include gene mutation) [2]
Lack of Fibrillin covering elastin due to mutation in FBN1 gene.
Can cause aortic aneurysm which burst
What is definiton of SIDs? [1]
Sudden unexpected death of an infant under 12 months of age. Death reamins unexplained after a thorough post-mortem examination
How can you reduce liklihood of SIDs? [6]
Lay baby down on their back for 1st 12 months. On stomach they’re likely to suffocate.
Remove loose blankets and toys
Reduce second hand smoke
Breastfeed
Baby in cot in same room
Monitor babys temp.
Give a dummy only after 6-8 weeks
Non-specific post mortem findings in SIDS? [8]
- Thymus with petechiae (round spots that appear on the skin as a result of bleeding)
- Petechiae in pleura
- Epicardial petechiae
- Full expansion of lungs
- Liquid heart blood
- Empty bladder
- Prominent lymph nodes & Peyer’s patches
What mechanism continues within the liver in SIDs children? [1]
Persistent haemopoiesis in the liver
What is it difficult to differentiate betwen with SIDs? [1]
Hard to distinguish between SIDs and suffocation
Lung changes in SIDs? [2]
Oedema / hemorrhaging
Explain pathology behind shaken baby syndrome (caused by a triad off..) [3]
Caused by
* sub-dural hematoma - most common
* encephalopathy;
* retinal haemorrhages
Which pathologies may cause fractures in newborns? [5]
- Sometimes seen in vaginal delivery
- Osteopenia of prematurity (neonatal ricket)
- Vitamin D deficiency especially in breast fed babies
- Osteogenesis imperfecta (brittle bone disease)
- Resuscitation
Explain the brain anomalies that are common in SIDs pathology
- Alterations (decreases) in serotonin signalling
- causes disturbances in medulla and ANS:
- leads to underdevelopment of arctuate nucleus which controls neuroendrocine & physiological functions
- Platelets carry around serotonin. More serotonin in platelets increases the stickiness.
Explain subset of SIDS infants related to serum platelet anomolies
Subset of SIDS infants have elevated serum serotonin platelets carry >98% of 5HT in blood:
Causes constriction of damaged blood vessels and enhances platelet aggregation
Which causative agent most likely caused this pneumonia? [1]
Cytomegalovirus
Parainfluenza virus
Respiratory syncytial virus
Adenovirus
Which causative agent most likely caused this pneumonia? [1]
Cytomegalovirus
Parainfluenza virus
Respiratory syncytial virus - Multinucleated giant cells can be seen within the bronchial epithelium and neighboring alveoli.
Adenovirus
What type of virus caused this lung infection? [1]
RSV
. Multinucleated giant cell (MNGC) of respiratory syncytial virus infection
demonstrating a large intracytoplasmic inclusion (arrow); (H&E, 1000 ). MNGCs
are more commonly seen within alveoli than within bronchioles.
