Appendix B

Stillborn Examination

A complete physical examination of the stillborn is a critical component of an etiologic investigation. The Stillborn Examination and Investigation Record (Form # HS001-128) will facilitate documentation of the physical exam and completed investigations.

The following is one approach to the physical exam suggested by Dr. R.L.H. Honore, Professor of Pathology at the University of Alberta. This approach, according to Dr. Honore, should not take long to perform since most stillborns will exhibit few, if any, external anomalies which once recognized or suspected can be examined in greater detail. The compiled list of external findings can be integrated with other relevant data (i.e., complete clinical history, ultrasonic, radiologic, microbiologic, cytogenetic findings and autopsy results).

The examination of the stillborn can be divided into five segments, which should be examined separately and systematically.

  1. General – Global evaluation of the following parameters:
    • State of Preservation: fresh or macerated (degree of maceration); intact delivery or interventions required to effect delivery
    • Weight, Gestational Age, Size for Gestational Age
    • Measurements: circumference of the head, chest and abdomen and lengths of the crown-heel (with leg fully extended), crown-rump and foot
  2. Craniofacial
    • General impression of normality or abnormality
      • as craniofacial height is roughly equal to the cranial vault height, abnormalities in the ratio indicate microcephaly or hydrocephaly
      • as the intercanthal distance is roughly equal to the orbit width, an abnormal ratio suggests hypo/hypertelorism
      • abnormal ear location – normally external meatus lies above level of nostrils and long axis of the ear is nearly vertical
    • Specific structural defects
    • Anterior – flat nasal bridge; short flat nose; small eyes; epicanthal folds; cleft lip (uni/bilateral or median); cleft palate; small mouth; down turning angles of mouth; glossoptosis and retro/prognathism
    • Posterior – anencephaly, iniencephaly and encephalocele (usually occipital)
  3. Neck
    • Abnormally short
    • Thickened nuchal fold and cystic hygroma
    • Cervical rachischisis and meningomyelocele
  4. Trunk
    • Overview – presence of edema; abdominal distention and muscular development
    • Specific Defects:
      • Ventral – omphalocele; umbilical hernia; gastroschisis; diastasis recti and prune belly
      • Dorsal – rachischisis; meningocele and meningomyelocele
      • Cord Insertion – normal location; number of vessels and juxtafetal cord stricture with abnormally thin umbilical ring
      • External Genitalia – absent; ambiguous and small or enlarged structures (penis, scrotum, clitoris and labia)
      • Anus – patency, imperforate, stenotic and displaced anteriorly
  5. Extremities
    • General – normal/abnormal length; shortening of particular segment and muscle development
    • Specific Defects:
      • Upper – distortions; amputations; pterygia; finger lengths; shape and size; poly/syndactyly and abnormal palmar creases
      • Lower – positional abnormalities of feet, toe lengths, shape and size; increased sandal space; poly/syndactyly and rocker-bottom deformity