Maceration is a medical term used to describe the condition of damaged skin. This condition begins with blistered skin, peeling so that later it is released. Maceration can be one tool to estimate the time and cause of fetal death.
The incidence of babies dying in the womb that occurs when the condition of the age of the fetus has reached 20 weeks or more, or when the fetus has weighed 500 grams and above, is called a stillbirth. This condition is different from miscarriage, which is when the age of the fetus in the womb has not reached 20 weeks.
Various Causes of Fetal Death in the Womb
The stillbirth condition mostly occurs in healthy fetuses. The death can be caused by many factors, but some of the causes are unknown. One of the risk factors for causing a baby to die in the womb is a disruption in the placenta, the organ that connects the fetus to the mother.
The placenta functions to supply blood and nourish the fetus in the womb. Problems with the placenta can trigger fetal disorders, whether in the form of fetal death (stillbirth) or cause fetal growth restriction.
Apart from interference with the placenta, stillbirth can also be caused by:
- Preeclampsia, which is high blood pressure experienced by pregnant women.
- Occurrence of bleeding in the mother, before or when giving birth.
- History of diabetes since before pregnancy.
- The existence of liver disorders in the mother during pregnancy.
- Infection in the mother, which then impacts the fetus.
- Genetic disorders in the fetus.
- Placental abruption, ie release of the placenta from the uterus before the fetus is born.
- The umbilical cord is slipped into the bottom and then wrapped around the fetus.
To find out the exact cause of infant death, it is important to do laboratory testing and examination of the placenta and other fetal tissue. Unfortunately, even though the procedure has been performed, doctors still often have difficulty finding the exact cause and time of fetal death.
Maceration can be a sign that the fetus has died in the womb. When a complete autopsy procedure on a fetus born in a state of death is not possible, external examination procedures on the fetus including maceration, can be used to estimate the time of fetal death.
An examination of the changes seen in a stillborn fetus can help estimate the time of fetal death, although it cannot be sure of the exact time of death.
Maceration Can Help Determine the Time of Fetal Death
The following are signs of maceration that can occur in stillbirths:
- The umbilical cord is brown or red, or desquamated (peeling) by 1 cm or more, indicating that the fetus has died for at least six hours.
- If desquamation occurs on the face, stomach and back, it is a sign that the fetus has died for at least 12 hours.
- If desquamation of 5% of the entire body or desquamation of two or more of the body (such as the scalp, face, neck, back, chest, arms, hands, testicular pouches, thighs, and legs), indicates that the fetus has died for at least 18 hours.
- Fetal skin color is brown or dark brown / black, indicating that the fetus has died for at least 24 hours.
- Mummification, which is reduced soft tissue volume, rough skin and fetal tissue that is dark brown and stained, indicates that the fetus has been dead for at least two weeks.
Maceration can help doctors estimate the time of fetal death. However, to determine the exact time of death of the fetus in the womb, it must still use other methods of examination that are more accurate.