Impact of the delay between fetal death and delivery on the success of postmortem ultrasound following termination of pregnancy.

Abstract

Objective: To evaluate the impact of the delay between\xa0fetal death and\xa0delivery\xa0on the nondiagnostic rates\xa0of\xa0post-mortem ultrasound (PM-US), following\xa0termination of pregnancy (TOP). Methods: We reviewed 204 cases of fetal two-dimensional PM-US performed in our centre as part of a post-mortem imaging research program, over the last 5\xa0years. Informed consent was obtained from the parents for all cases. PM-US was performed and reported according to a prespecified template with operators blinded to the prenatal diagnosis. In order to calculate the precise delay between the fetal death and the delivery, we included 107 fetal TOP s ≥ 20\xa0weeks of gestational age (GA), where feticide was performed using injection of lidocaine 2% prior to induction of labour. Logistic regression analysis was conducted to analyze the impact of delay between fetal death and delivery (in hours), the GA (gestational age) at TOP (in weeks) and the method of feticide (intracardiac versus intraumbilical injection) on the PMUS nondiagnostic rates. Results: The delay between fetal death and delivery increased the nondiagnostic rate of PM-US for cerebral examinations (OR: 1.04, IC 95%: 1.01-1.08, p < 0.05). For PM-US cardiac examination, the delay did not influence the nondiagnostic rate. However, GA (OR: 1.25, IC 95%: 1.10-1.46, p < 0.01) and feticide with intracardiac injection (OR: 4.29, IC 95%: 1.68-12.02, p < 0.01) were associated with higher nondiagnostic rates. For noncardiac thoracic and abdominal examinations, none of the studied variables influenced the nondiagnostic rate. Conclusion: The success rate of cerebral PM-US was influenced by the delay between fetal death and delivery, suggesting a possible advantage of performing the feticide closer to the delivery where examination of the brain is planned. For cardiac abnormalities,\xa0feticide by intraumbilical,\xa0rather than intracardiac injection improves diagnostic rates of cardiac PM-US.