An approximate time for intrauterine fetal demise of a stillborn infant can be reached from clinical and postmortem findings.
Maternal Examination Prior to Delivery
(1) most women can accurately recognize fetal movements
(2) cessation of movements is usually followed by fetal death within 24 hours.
Fetal heart monitoring:
(1) false positive assessment can occur if maternal pulse taken
Examination of Fetus
Grade of Maceration
Duration of Intrauterine Demise
• "parboiled" reddened skin
< 8 hours
• skin slippage and peeling
> 8 hours
• extensive skin peeling
• red serous effusions in chest and abdomen due to hemoglobin staining
• liver yellow-brown
• turbid effusion
• may be mummified
>= 8 days
(1) bullae in epidermis (leading to peeling): appear at about 24 hours
(2) hemoglobin staining of internal viscera (loss of normal color): 24-48 hours
(3) separation of dura from calvarium bone: 5+ days
• Very edematous liveborn infants can have skin peeling.
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Specialty: Clinical Laboratory, Pedatrics