Fetal liver calcifications: an autopsy study

Fetal liver calcifications are occasionally found in fetal autopsies. However, the incidence, associated findings, clinical significance, and presumed pathogenesis of fetal liver calcifications are not well documented. This study analyzed the characteristics and significance of fetal liver calcifications found on fetal autopsies. Cases of fetal liver calcifications were collected from a fetal autopsy database. Their clinical and pathological characteristics were analyzed in comparison to the remaining cases in the database. Thirty-five cases (4.2%) of fetal liver calcifications were found among 827 consecutive fetal autopsies that had been performed in our hospital during the 16-year period from January 1, 1994 through December 31, 2009. Twenty-nine cases had nodular calcifications, predominantly subcapsular. Calcification in portal spaces and porta hepatis were present in six cases. Twenty cases were missed abortions and intrauterine fetal death. Missed abortion at or earlier than 23 weeks had significantly more subcutaneous edema and other evidence of circulatory abnormalities. Calcifications in older fetuses (>23 weeks) were located more commonly in portal spaces and in other organs. Fetal liver calcification is an incidental finding during autopsies. The significance of fetal liver calcifications has to be assessed in combination with other clinical and pathological parameters, including location and number of the lesions, signs of circulatory compromise, and abnormalities of placenta, umbilical cord, and fetal malformations. Fetal liver calcifications are commonly associated with conditions related to impaired circulation, including umbilical cord abnormalities and subcutaneous edema. We suggest that fetal liver calcifications might attest to circulatory compromise preceding death, especially if subcutaneous edema is present and even when no other abnormal findings are seen.