Embolism of brain tissue in intrapartum and early neonatal deaths: report of 9 cases

Cox, Phillip, Silvestri, Evelina, Lazda, Edgar Janis, Nash, Ruth, Jeffrey, Iona, Ostojic, Nikola and Wigglesworth, Jonathan 2009. Embolism of brain tissue in intrapartum and early neonatal deaths: report of 9 cases. Pediatric and Developmental Pathology 12 (6) , pp. 464-468. 10.2350/09-02-0607-OA.1

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Abstract

We report the clinical features and pathological findings in 9 cases of intrapartum and early neonatal death associated with embolism of brain tissue to the pulmonary and systemic circulation following difficult delivery. All except 1 of the cases in this series were born at, or near to, term, were vertex presentations, and were normally grown. All followed instrumental delivery and in 5, at least one mode of assisted delivery had failed. Whilst some evidence of cranial trauma was present in 7 cases, only 3 had skull fractures and 7 showed intracranial hemorrhage, although this was described as minor in 3. Emboli of brain tissue were identified in the pulmonary circulation in all cases. Fragments of brain were also seen in vessels of other organs, in particular the heart, in 6 cases. Emboli were highlighted by immunostaining for glial fibrillary acid protein. Brain emboli should be sought in all post mortems of unexplained intrapartum or early neonatal death following difficult delivery, even in the absence of overt cranial trauma. Disseminated intravascular coagulation is a frequent association. Extensive sampling for histology, particularly of the lungs and coronary vessels, is essential if this condition is not to be missed.

Item Type:	Article
Date Type:	Publication
Status:	Published
Schools:	Medicine
Subjects:	R Medicine > RG Gynecology and obstetrics
Uncontrolled Keywords:	birth injuries, embolism, neonatal mortality, obstetric forceps, pathology
Publisher:	Allen Press
ISSN:	1093-5266
Last Modified:	19 Mar 2016 23:38
URI:	https://orca.cardiff.ac.uk/id/eprint/59007

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