{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T06:59:23Z","timestamp":1785135563731,"version":"3.55.0"},"reference-count":37,"publisher":"MDPI AG","issue":"15","license":[{"start":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T00:00:00Z","timestamp":1785110400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background: Perinatal deaths remain a major public health concern and present unique medico-legal challenges. Forensic autopsy plays a crucial role in determining the cause of death, distinguishing live birth from stillbirth, assessing fetal viability, and identifying traumatic or non-natural causes of death. Methods: This retrospective study included all perinatal cases referred to the Gaziantep Forensic Medicine Group Presidency between 2021 and 2024. Demographic characteristics, gestational age, autopsy findings, histopathological and toxicological examinations, hydrostatic lung test results, and final forensic diagnoses were evaluated. Results: Seventeen of 339 infant forensic cases met the inclusion criteria. Fourteen underwent complete forensic autopsy, whereas three were evaluated by external postmortem examination and medical records. Despite a multidisciplinary forensic investigation that included external examination, complete forensic autopsy, systematic macroscopic organ evaluation, routine histopathological examination, hydrostatic lung flotation testing, toxicological analysis when indicated, review of maternal medical and obstetric records, judicial investigation records, and placental and umbilical cord histopathology whenever available, no definitive cause of death could be established in six cases. Advanced decomposition prevented determination in two cases. One case was classified as an undiagnosed natural death, whereas no specific cause of death could be assigned in the remaining three cases. Placental examination was available in only a minority of cases, whereas umbilical cord histopathology was performed in nearly all autopsied cases. Causes of death included traumatic injury, pulmonary immaturity, intrauterine infection, congenital anomalies, maternal drug exposure, placental abruption, maternal disease, and umbilical cord pathology. Conclusions: Perinatal death investigations require a multidisciplinary forensic approach integrating autopsy, histopathology, toxicology, placental examination, and clinical information. Beyond determining the cause of death, forensic evaluation is essential for assessing live birth, fetal viability, suspected abuse, maternal violence, medical malpractice, and criminal investigations.<\/jats:p>","DOI":"10.3390\/diagnostics16152341","type":"journal-article","created":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T05:49:27Z","timestamp":1785131367000},"page":"2341","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Perinatal Deaths: Autopsy Findings and Medico-Legal Evaluation from a Forensic Medicine Perspective"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7744-6305","authenticated-orcid":false,"given":"Sertac","family":"Dalgic","sequence":"first","affiliation":[{"name":"Akhisar Forensic Medicine Branch Office, The Council of Forensic Medicine, 45000 Manisa, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abuzer","family":"Gulderen","sequence":"additional","affiliation":[{"name":"Gaziantep Forensic Medicine Group Presidency, The Council of Forensic Medicine, 27000 Gaziantep, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Murat","family":"Kamalak","sequence":"additional","affiliation":[{"name":"Gaziantep Forensic Medicine Group Presidency, The Council of Forensic Medicine, 27000 Gaziantep, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ibrahim","family":"Uzun","sequence":"additional","affiliation":[{"name":"1st Forensic Medicine Specialization Department, The Council of Forensic Medicine, 34000 Istanbul, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"180","DOI":"10.1038\/s41591-022-02142-1","article-title":"Genomic autopsy to identify underlying causes of pregnancy loss and perinatal death","volume":"29","author":"Byrne","year":"2023","journal-title":"Nat. Med."},{"key":"ref_2","first-page":"e33878","article-title":"A Compendium on Perinatal Autopsy in Neonates","volume":"15","author":"Joshi","year":"2023","journal-title":"Cureus"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"62","DOI":"10.2471\/BLT.22.288703","article-title":"Maternal and perinatal death surveillance and response: A systematic review of qualitative studies","volume":"101","author":"Willcox","year":"2023","journal-title":"Bull. World Health Organ."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1002\/ijgo.14100","article-title":"Maternal and perinatal complications according to maternal age: A systematic review and meta-analysis","volume":"159","author":"Saccone","year":"2022","journal-title":"Int. J. Gynaecol. Obstet."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"780","DOI":"10.1055\/s-0041-1731276","article-title":"Differences in Postmortem Investigation following Perinatal Death","volume":"40","author":"Nestander","year":"2023","journal-title":"Am. J. Perinatol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1016\/j.wombi.2023.09.006","article-title":"A systematic review of standardised tools used in perinatal death review programmes","volume":"37","author":"Leitao","year":"2024","journal-title":"Women Birth J. Aust. Coll. Midwives"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"e195","DOI":"10.1016\/j.wombi.2022.07.170","article-title":"Women\u2019s experiences of care and support following perinatal death in high burden countries: A metasynthesis","volume":"36","author":"Kuforiji","year":"2023","journal-title":"Women Birth J. Aust. Coll. Midwives"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"101159","DOI":"10.1016\/j.gim.2024.101159","article-title":"A systematic review to assess the utility of genomic autopsy using exome or genome sequencing in cases of congenital anomalies and perinatal death","volume":"26","author":"Schubert","year":"2024","journal-title":"Genet. Med."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Kingdom, J.C.P., Hutcheon, J.A., Gordijn, S.J., El Demellawy, D., and Grynspan, D. (2023). Placental pathology and pregnancy complications. J. Clin. Med., 12.","DOI":"10.3390\/jcm12155053"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"475","DOI":"10.1055\/s-0043-1764485","article-title":"Stillbirth investigations: An iconographic and concise diagnostic workup in perinatal pathology","volume":"15","author":"Sergi","year":"2023","journal-title":"J. Lab. Physicians"},{"key":"ref_11","first-page":"20211078","article-title":"Post-mortem perinatal imaging: What is the evidence?","volume":"96","author":"Shelmerdine","year":"2023","journal-title":"Br. J. Radiol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"e064774","DOI":"10.1136\/bmjopen-2022-064774","article-title":"Are non-invasive or minimally invasive autopsy techniques for detecting cause of death in prenates, neonates and infants accurate? A systematic review of diagnostic test accuracy","volume":"13","author":"Shenfine","year":"2023","journal-title":"BMJ Open"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"e19984","DOI":"10.1016\/j.heliyon.2023.e19984","article-title":"An audit of autopsy-confirmed diagnostic errors in perinatal deaths: What are the most common major missed diagnoses?","volume":"9","author":"Xu","year":"2023","journal-title":"Heliyon"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1007\/s00404-024-07522-1","article-title":"Identifying causes and associated factors of stillbirths using autopsy of the fetus and placenta","volume":"311","author":"Sade","year":"2025","journal-title":"Arch. Gynecol. Obstet."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"630","DOI":"10.1080\/15513815.2023.2201623","article-title":"Comparison of prenatal and postmortem diagnoses from 251 fetal autopsies: High rate of placental pathologies, low rate of discrepancies","volume":"42","author":"Suhren","year":"2023","journal-title":"Fetal Pediatr. Pathol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1016\/j.placenta.2023.04.013","article-title":"Placental pathology findings amongst extremely preterm perinatal deaths in Aotearoa New Zealand","volume":"137","author":"Bartlett","year":"2023","journal-title":"Placenta"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1811","DOI":"10.1007\/s00404-022-06614-0","article-title":"Placental pathology in sudden intrauterine death (SIUD) in SARS-CoV-2-positive oligosymptomatic women","volume":"307","author":"Horn","year":"2023","journal-title":"Arch. Gynecol. Obstet."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"406","DOI":"10.1177\/10935266261419538","article-title":"Perinatal Autopsy Guidance for the General Pathologist","volume":"29","author":"Rogers","year":"2026","journal-title":"Pediatr. Dev. Pathol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"388","DOI":"10.1177\/10935266231178151","article-title":"Anatomy of the ductus arteriosus in fetal autopsies: Correlations with placental pathology and cause of death","volume":"26","author":"Ernst","year":"2023","journal-title":"Pediatr. Dev. Pathol."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Montana, A., Alfieri, L., Marino, R., Greco, P., Taliento, C., Fulcheri, E., Tini, A., Buffelli, F., and Neri, M. (2024). Sudden intrauterine unexplained death (SIUD) and oxidative stress. Cells, 13.","DOI":"10.3390\/cells13161347"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1515\/jpm-2016-0337","article-title":"Causes of intrauterine fetal death are changing in recent years","volume":"46","author":"Takita","year":"2018","journal-title":"J. Perinat. Med."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1177\/10935266231164446","article-title":"Synoptic reporting in clinical placental pathology","volume":"26","author":"Dancey","year":"2023","journal-title":"Pediatr. Dev. Pathol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1016\/j.placenta.2023.11.005","article-title":"Automated detection of microscopic placental features using machine learning","volume":"145","author":"Patnaik","year":"2024","journal-title":"Placenta"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1080\/15513815.2023.2299491","article-title":"Autopsy-based growth charts may under-detect fetal growth restriction at autopsy","volume":"43","author":"Kim","year":"2024","journal-title":"Fetal Pediatr. Pathol."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Scalise, C., Cordasco, F., Sacco, M.A., Ricci, P., and Aquila, I. (2022). The Importance of Post-Mortem Investigations in Stillbirths: Case Studies and a Review of the Literature. Int. J. Environ. Res. Public Health, 19.","DOI":"10.3390\/ijerph19148817"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1016\/j.ogc.2019.10.005","article-title":"When the Fetus Goes Still and the Birth Is Tragic: The Role of the Placenta in Stillbirths","volume":"47","author":"Graham","year":"2020","journal-title":"Obstet. Gynecol. Clin. N. Am."},{"key":"ref_27","first-page":"e91471","article-title":"Pathological Insights: Placental and Umbilical Cord Changes in Stillbirth","volume":"17","author":"Sr","year":"2025","journal-title":"Cureus"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1203","DOI":"10.1097\/AOG.0000000000005188","article-title":"Interpregnancy Interval After Stillbirth and Adverse Perinatal Outcomes","volume":"141","author":"Gibbins","year":"2023","journal-title":"Obstet. Gynecol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1007\/s00404-025-07955-2","article-title":"Value of CODAC classification in identifying causes of stillbirths","volume":"312","author":"Mekni","year":"2025","journal-title":"Arch. Gynecol. Obstet."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"3939","DOI":"10.1080\/14767058.2018.1479390","article-title":"Placenta in intrauterine fetal demise (IUFD): A comprehensive study from a tertiary care hospital","volume":"32","author":"Manocha","year":"2019","journal-title":"J. Matern.-Fetal Neonatal Med."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Debelenko, L. (2023). SARS-CoV-2 infection in late pregnancy and childbirth from the perspective of perinatal pathology. J. Dev. Biol., 11.","DOI":"10.3390\/jdb11040042"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1097\/AOG.0000000000004883","article-title":"Pathologic assessment of the placenta: Evidence compared with tradition","volume":"140","author":"Pinar","year":"2022","journal-title":"Obstet. Gynecol."},{"key":"ref_33","first-page":"431","article-title":"Autopsies and placental examinations of perinatal fetal deaths: A clinicopathological analysis of 105 cases","volume":"51","author":"Wang","year":"2022","journal-title":"Zhonghua Bing Li Xue Za Zhi"},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Jovanovic, I., Ivanovic, K., Kostic, S., Tadic, J., Dugalic, S., Petronijevic, M., Gojnic, M., Petronijevic, M., and Vrzic-Petronijevic, S. (2023). Intrauterine Fetal Death in Term Pregnancy-A Single Tertiary Clinic Study. Life, 13.","DOI":"10.20944\/preprints202310.1390.v1"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1111\/cge.70028","article-title":"Evaluating the Clinical Utility of Genomic Sequencing After Perinatal Death","volume":"109","author":"Schubert","year":"2026","journal-title":"Clin. Genet."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"454","DOI":"10.1002\/pd.6522","article-title":"Improving prenatal diagnosis through standards and aggregation","volume":"44","author":"Duyzend","year":"2024","journal-title":"Prenat. Diagn."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1045","DOI":"10.1177\/0030222820926296","article-title":"Rural Perinatal Loss: A Needs Assessment","volume":"84","author":"Domogalla","year":"2022","journal-title":"Omega"}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/15\/2341\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T06:05:21Z","timestamp":1785132321000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/15\/2341"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,27]]},"references-count":37,"journal-issue":{"issue":"15","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["diagnostics16152341"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics16152341","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,27]]}}}