{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T02:50:52Z","timestamp":1784170252747,"version":"3.55.0"},"reference-count":19,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2016,10,25]],"date-time":"2016-10-25T00:00:00Z","timestamp":1477353600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"NIHR Senior Investigator award"},{"name":"Great Ormond Street Hospital Children's Charity"},{"name":"NIHR Biomedical Research Centre at Great Ormond Street Hospital"},{"name":"Sands (Stillbirth and neonatal death society)"},{"name":"NIHR Clinician Scientist fellowship"},{"DOI":"10.13039\/501100009324","name":"Tommy's","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100009324","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ultrasound in Obstet &amp; Gyne"],"published-print":{"date-parts":[[2016,11]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>According to the classification system used, 15\u201360% of stillbirths remain unexplained, despite undergoing recommended autopsy examination, with variable attribution of fetal growth restriction (<jats:styled-content style=\"fixed-case\">FGR<\/jats:styled-content>) as a cause of death. Distinguishing small\u2010for\u2010gestational age (<jats:styled-content style=\"fixed-case\">SGA<\/jats:styled-content>) from pathological <jats:styled-content style=\"fixed-case\">FGR<\/jats:styled-content> is a challenge at postmortem examination. This study uses data from a large, well\u2010characterized series of intrauterine death autopsies to investigate the effects of secondary changes such as fetal maceration, intrauterine retention and postmortem interval on body weight.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Autopsy findings from intrauterine death investigations (2005\u20132013 inclusive, from Great Ormond Street Hospital and St George's Hospital, London) were collated into a research database. Growth charts published by the World Health Organization were used to determine normal expected weight centiles for fetuses born \u2265 24 weeks' gestation, and the effects of intrauterine retention (maceration) and postmortem interval were calculated.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>There were 1064 intrauterine deaths, including 533 stillbirths \u2265 24 weeks' gestation with a recorded birth weight. Of these, 192 (36%) had an unadjusted birth weight below the 10<jats:sup>th<\/jats:sup> centile and were defined as <jats:styled-content style=\"fixed-case\">SGA<\/jats:styled-content>. The majority (86%) of stillborn <jats:styled-content style=\"fixed-case\">SGA<\/jats:styled-content> fetuses demonstrated some degree of maceration, indicating a significant period of intrauterine retention after death. A significantly greater proportion of macerated fetuses were present in the <jats:styled-content style=\"fixed-case\">SGA<\/jats:styled-content> population compared with the non\u2010<jats:styled-content style=\"fixed-case\">SGA<\/jats:styled-content> population (<jats:italic>P =<\/jats:italic> 0.01). There was a significant relationship between increasing intrauterine retention interval and both more severe maceration and reduction in birth weight (<jats:italic>P<\/jats:italic> &lt; 0.0001 for both), with an average artifactual reduction in birth weight of around \u22120.<jats:styled-content style=\"fixed-case\">8 SD<\/jats:styled-content> of expected weight. There was an average 12% reduction in fetal weight between delivery and autopsy and, as postmortem interval increased, fetal weight loss increased (<jats:italic>P<\/jats:italic> = 0.0001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Based on birth weight alone, 36% of stillbirths are classified as <jats:styled-content style=\"fixed-case\">SGA<\/jats:styled-content>. However, fetuses lose weight <jats:italic>in utero<\/jats:italic> with increasing intrauterine retention and continue to lose weight between delivery and autopsy, resulting in erroneous overestimation of <jats:styled-content style=\"fixed-case\">FGR<\/jats:styled-content>. Copyright \u00a9 2016 ISUOG. Published by John Wiley &amp; Sons Ltd.<\/jats:p><\/jats:sec>","DOI":"10.1002\/uog.16018","type":"journal-article","created":{"date-parts":[[2016,10,26]],"date-time":"2016-10-26T00:02:46Z","timestamp":1477440166000},"page":"574-578","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":52,"title":["Effects of intrauterine retention and postmortem interval on body weight following intrauterine death: implications for assessment of fetal growth restriction at autopsy"],"prefix":"10.1002","volume":"48","author":[{"given":"J.","family":"Man","sequence":"first","affiliation":[{"name":"Department of Histopathology, Camelia Botnar Laboratories Great Ormond Street Hospital  London UK"},{"name":"University College London, Institute of Child Health  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. C.","family":"Hutchinson","sequence":"additional","affiliation":[{"name":"Department of Histopathology, Camelia Botnar Laboratories Great Ormond Street Hospital  London UK"},{"name":"University College London, Institute of Child Health  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Ashworth","sequence":"additional","affiliation":[{"name":"Department of Histopathology, Camelia Botnar Laboratories Great Ormond Street Hospital  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A. E.","family":"Heazell","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology St Mary's Hospital  Manchester UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"Levine","sequence":"additional","affiliation":[{"name":"Department of Histopathology St George's Hospital  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"N. J.","family":"Sebire","sequence":"additional","affiliation":[{"name":"Department of Histopathology, Camelia Botnar Laboratories Great Ormond Street Hospital  London UK"},{"name":"University College London, Institute of Child Health  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2016,10,25]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(80)92717-8"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.38629.587639.7C"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/0140-6736(92)91342-6"},{"key":"e_1_2_6_5_1","unstructured":"RCOG.The Investigation and Management of the Small\u2010For\u2010Gestational\u2010Age Fetus. 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