Brain injury and intrauterine death

Many of the stresses contributing to brain injury in the intrapartum or neonatal period may also exist prenatally. To define this problem, we reviewed the clinical features and neuropathologic findings in 433 consecutive stillbirth autopsies. Twenty-five had evidence of periventricular/intraventricular hemorrhage or gliosis. Twenty infants had died in utero before active labor and five during delivery. Nine stillbirths were infected. Ten cases had periventricular/intraventricular hemorrhage alone, five had the hemorrhage with parenchymal hemorrhage, five had parenchymal hemorrhage only, and five had gliosis. This group of 25 cases establishes that intrauterine brain injury is not rare. Separation of antepartum events occurring in utero from those imposed during labor, delivery, resuscitation, and the neonatal period is very important and has significant medical and legal implications.