Dating of the intrauterine fetal demise
A series of articles (References 1-3) appeared in 1992 which made such estimation much more precise.
Certainly differentiation of intrapartum and prepartum deaths is relevant to the assessment of any methods of intervention or prevention; intrapartum deaths are less often of fetal origin and may include instances more amenable to medical intervention.Sloughing of skin from larger and greater number of surfaces indicates that the interval between death and delivery is longer.With antenatal death more than a few days prior to delivery other changes begin to occur including generalized hypermobility of joints, change in the color of the fetal skin surfaces to a pale grey-yellow and liquefaction of internal organs.The loss of a fetus at any stage is a fetal demise.According to the 2003 revision of the Procedures for Coding Cause of Fetal Death Under ICD-10, the National Center for Health Statistics defines fetal death as "death prior to the complete expulsion or extraction from its mother of a product of human conception, irrespective of the duration of pregnancy and which is not an induced termination of pregnancy.Bullae (blisters) may develop (which should not be misinterpreted as being secondary to an abnormality of development such as epidermolysis bullosa).
These bullae rupture spontaneously or from delivery resulting in patchy denudation of the skin.
The death is indicated by the fact that after such expulsion or extraction, the fetus does not breathe or show any other evidence of life, such as beating of the heart, pulsation of the umbilical cord, or definite movement of voluntary muscles.
Heartbeats are to be distinguished from transient cardiac contractions; respirations are to be distinguished from fleeting respiratory efforts or gasps." In the United States, the term stillbirth or fetal demise does not have a standard definition.
For example, it is uncommon to have ultrasonographic evaluations close enough together to bracket the time of death accurately.
Most often, then, assessing severity of maceration is the only method available for confirming when death occurred.
Maceration and the Timing of Intrauterine Death Richard M. Since this process occurs in what is usually a sterile environment, the changes which arise are unlike those which occur following other deaths.