By The University of Chicago Department of Pathology
Auto text: “Insert Fetus”
First, check the birthing status and gestational age of all fetuses:
Any LIVE birth (regardless of age): These go directly to autopsy pending permit.
20 weeks or more and/or 500 gm or more: These go directly to autopsy pending permit.
Less than 20 weeks (and stillbirth or termination): These are processed as surgical specimens, unless an autopsy is requested with proper permit.
Photograph front and back of all intact fetuses.
If x-rays are warranted (as in suspicion for skeletal anomalies such as osteogenesis imperfecta or dwarfism):
You can take x-rays of limbs or small specimens using the Faxitron® in the gross room.
For a dedicated scan, call Peds Radiology in Comer 5-2053 (Reading Room) (backup 2-6161) and arrange a time to bring specimen for Fetal Demise Survey “XR P Fetal Demise OSS Scn.” To schedule the scan, please call 2-3455. Once there, fill out a paper requisition using MRN 9990123. (This is the general pathology MRN. The fetus will not have its own MRN; Do not use the mother’s MRN.) Images will appear in Epic under this MRN.
If cytogenetic studies are warranted, take pieces of fresh skin in RPMI and send to Clinical Cytogenetics lab with requisition.
Fetuses should be grossed the same day that they are received.
The organs should be dissected and examined — The only exception is if the clinician requests that no dissection should occur. Then do an external exam only.
Fetus – external examination:
Measure the following:
Crown to rump
Crown to heel
Note the following:
Spinal column and/or cranial defects
Morphology of hands/feet (rockerbottom, clubbed, polydactyly, syndactyly)
Transpalmar (simian) crease
Patency of eyes, nose, mouth, anus
Craniofacial defects (cleft lip/palate/nose)
Placement of ears
If a GROSS EXAM ONLY is requested by the physician, DO NOT DISSECT the fetus, and note this in your dictation.
After the external examination is complete, the fetus should be opened with the standard Y-incision:
Identify that the organs are in the correct anatomic location
Identify and remove the gonads – do this before any other dissection.
Remove and section organ systems (heart, lungs, thymus, kidneys, adrenals, liver, spleen, pancreas, pelvic organs)
Place tissue back in the body cavity, wrap the fetus in gauze and return back to formalin.
If a placenta or products of conception is submitted with the fetus, then process according to standard procedure (3 cassettes of placental tissue plus umbilical cord and membranes if identifiable).
Tissues to submit that may show signs of fetal distress: Pancreas, Adrenals, Thymus, Bone Marrow (rib at costochondral junction), Lungs (for infection)
Tissue to submit that may help date the gestation: Kidneys