Unexplained antenatal fetal death in full-term pregnancy
Kurtser M.A., Kalashnikov S.A., Voskoboeva K.Yu.
Objective. To identify the features of anamnestic data, the course of pregnancy and the results of pathological examination in patients with antenatal death of full-term fetuses depending on the presence of meconium in the amniotic fluid.
Materials and methods. A retrospective analysis of individual pregnancy records, birth histories, and autopsy reports for 83 cases of stillbirth from 2021 to 2023 was conducted. The patients were divided into 2 groups: Group I included the patients with meconium-stained amniotic fluid (MSAF) (n=55); Group II included the patients with clear amniotic fluid (n=28).
Results. The patients in Group I most often had a history of induced abortion (p=0,048), abnormal placental attachment, and oligohydramnios, that can be a marker of MSAF (p=0,041). At the time of fetal death, the length of pregnancy in Group I was longer than in Group II (p=0,003). The frequency of fatty involution of thymus was comparable in stillbirths in both groups. The signs of chronic placental insufficiency and inflammatory-immune disorders were observed in most placental samples collected from both groups.
Conclusion. No direct association was found between fetal distress that led to antenatal death and MSAF. The probability of MSAF increases with increasing gestational age and oligohydramnios. More intensive fetal monitoring is essential in the second half of the third trimester of pregnancy in high-risk patients.
Authors' contributions. Kurtser M.A., Kalashmicov S.A. – the study concept and design, manuscript editing; Voskovoeva K.Yu. – material collection and processing, statistical data processing; Kalashnikov S.A., Voskoboeva K.Yu. – manuscript writing.
Conflicts of interest. The authors confirm that they have no conflict of interest to declare.
Funding. The authors received no funding for this study.
Ethical Approval. The study was approved by the local Ethics Committee of Pirogov Russian National Research Medical University, Ministry of Health of Russia (Pirogov University) (protocol No. №235 of December 18, 2023).
Generative Artificial Intelligence. No generative AI was used in preparing this article.
Patient Consent for Publication. All patients whose data are included in the study have signed informed voluntary consent that the results of examination and treatment will be used for scientific purposes and their data will be published.
Authors' Data Sharing Statement. The data supporting the findings of this study are available on request from the corresponding author after approval from the principal investigator.
For citation: Kurtser M.A., Kalashnikov S.A., Voskoboeva K.Yu. Unexplained antenatal fetal death in full-term pregnancy
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2026; (6): 101-108 (in Russian)
https://dx.doi.org/10.18565/aig.2026.30
Keywords
antenatal fetal death
antenatal care
autopsy
meconium-stained amniotic fluid
stillbirth
placental morphology
sudden fetal death syndrome
References
- Thornton H.V., Cornish R.P., Lawlor D.A. Non-linear associations of maternal pre-pregnancy body mass index with risk of stillbirth, infant, and neonatal mortality in over 28 million births in the USA: a retrospective cohort study. EClinicalMedicine. 2023; 66: 102351. https://dx.doi.org/10.1016/j.eclinm
- Щеголев А.И., Туманова У.Н., Чаусов А.А., Шувалова М.П. Сравнительный анализ причин мертворождения в Российской Федерации в 2019 и 2020 годах. Акушерство и гинекология. 2022; 2: 80-90. https://dx.doi.org/10.18565/aig.2022.2.80-90 [Shchegolev A.I., Tumanova U.N., Chausov A.A., Shuvalova M.P. Comparative analysis of stillbirth in the Russian Federation in 2019 and 2020. Obstetrics and Gynecology. 2022; (2): 80-90 (in Russian). https://dx.doi.org/10.18565/aig.2022.2.80-90].
- Гусак Ю.К., Чикин В.Г., Хованов А.В., Новикова А.В., Гусак Н.Ю. Антенатальная гибель плода: клинико-биохимические параллели и особенности родоразрешения. Главный врач Юга России. 2020; 5(75): 18-23 [Gusak Yu.K., Chikin V.G., Khovanov A.V., Novikova A.V., Gusak N.Yu. Antenatal fetal death: clinical and biochemical parallels and features of delivery. Glavnyy Vrach Yuga Rossii. 2020; 5(75): 18-23 (in Russian)].
- Merc M.D., Peterlin B., Lovrecic L. The genetic approach to stillbirth: a «systematic review». Prenat. Diagn. 2023; 43(9): 1220-8. https://dx.doi.org/10.1002/pd.6354
- Lavezzi A.M., Piscioli F., Pusiol T., Jorizzo G., Ferrero S. Sudden intrauterine unexplained death: time to adopt uniform postmortem investigative guidelines? BMC Pregnancy Childbirth. 2019; 19(1): 526. https://dx.doi.org/10.1186/s12884-019-2603-1
- Курцер М.А., Кутакова Ю.Ю., Сонголова Е.Н., Белоусова А.В., Каск Л.Н., Чемезов А.С. Синдром внезапной смерти плода. Акушерство и гинекология. 2011; 7(1): 79-83. [Kurtser M.A., Kutakova Yu.Yu., Songolova E.N., Belousova A.V., Kask L.N., Chemezov A.S. Sudden fetal death syndrome. Obstetrics and Gynecology. 2011; 7(1): 79-83 (in Russian)].
- Мочалова М.Н., Мудров В.А., Мудров А.А. Роль состава околоплодных вод в структуре перинатальной патологии. Журнал акушерства и женских болезней. 2019. 68(2): 95-108. https://dx.doi.org/10.17816/ JOWD68295-108 [Mochalova M.N., Mudrov V.A., Mudrov A.A. Amniotic fluid composition and its role in perinatal pathology. Journal of Obstetrics and Women's Diseases. 2019; 68(2): 95-108 (in Russian). https://dx.doi.org/10.17816/ JOWD68295-108].
- Avagliano L., Massa V., Bulfamante G. Meconium-stained amniotic fluid and histologic signs of fetal distress in stillbirths. Eur. J. Obstet. Gynecol. Reprod. Biol. 2021; 266: 55-62. https://dx.doi.org/10.1016/j.ejogrb.2021.09.016
- Karpe N.S., Tagad M.B., Holkar R.R., More V.S. Evaluation and association of meconium-stained amniotic fluid with fetal distress. Cureus. 2025; 17(5): e83295. https://dx.doi.org/10.7759/cureus.83295
- Gallo D.M., Romero R., Bosco M., Gotsch F., Jaiman S., Jung E. et al. Meconium-stained amniotic fluid. Am. J. Obstet. Gynecol. 2023; 228(5S): S1158-78. https://dx.doi.org/10.1016/j.ajog.2022.11.1283
- Jacques S.M., Qureshi F. Does in utero meconium passage in term stillbirth correlate with autopsy and placental findings of hypoxia or inflammation? J. Matern. Fetal. Neonatal. Med. 2022; 35(10): 1853-9. https://dx.doi.org/10.1080/14767058.2020.1770217
- Zong X.N., Li H., Zhang Y.Q., Wu H.H. Reference values and growth curves of weight/length, body mass index, and ponderal index of Chinese newborns of different gestational ages. Chin. J. Pediatr. 2021; 59(3): 181-8. https://dx.doi.org/10.3760/cma.j.cn112140-20201130-01063
- The International Fetal and Newborn Growth Consortium for the 21st Century. Available at: https://www.intergrowth21.org.uk
- Баринова И.В., Никольская И.Г., Котов Ю.Б., Прокопенко Е.И., Кондриков Н.И. Плацента при хронической болезни почек у беременных. Акушерство и гинекология. 2020; 1: 169-77. https://dx.doi.org/10.18565/aig.2020.1.169-177 [Barinova I.V., Nikolskaya I.G., Kotov Yu.B., Prokopenko E.I., Kondrikov N.I. Placenta in pregnant women with chronic kidney disease. Obstetrics and Gynecology. 2020; (1): 169-77 (in Russian). https://dx.doi.org/10.18565/aig.2020.1.169-177].
- Hayward C.E., Lean S., Sibley C.P., Jones R.L., Wareing M., Greenwood S.L. et al. Placental adaptation: what can we learn from Birthweight:Placental weight ratio? Front. Physiol. 2016; 5: 7-28. https://dx.doi.org/10.3389/fphys.2016.00028
- Пестрикова Т.Ю., Юрасова Е.А., Ткаченко В.А. Мекониальное окрашивание амниотической жидкости и его влияние на материнские и перинатальные исходы. Российский вестник акушера-гинеколога. 2024; 24(3): 42-7. https://dx.doi.org/10.17116/rosakush20242403142 [Pestrikova T.Yu., Yurasova E.A., Tkachenko V.A. Meconial staining of amniotic fluid and its influence on maternal and perinatal outcomes. Russian Bulletin of Obstetrician-Gynecologist. 2024; 24(3): 42-7 (in Russian). https://dx.doi.org/10.17116/rosakush20242403142].
- Åmark H., Westgren M., Sirotkina M., Hulthén Varli I., Persson M., Papadogiannakis N. Maternal obesity and stillbirth at term; placental pathology – a case control study. PLoS One. 2021; 16(4): e0250983. https://dx.doi.org/10.1371/journal.pone.0250983
- Sawant A.A., Wankhede S., Thakare S., Narayan G.N., Saha I., Vernekar A. et al. Maternal and perinatal outcomes in oligohydramnios: a cross-sectional analysis of pregnancies between 28 to 42 weeks of gestation. Cureus. 2025; 17(2): e79232. https://dx.doi.org/10.7759/cureus.79232
- Bynarowicz T., Jenkins S.M., Shanks A.L. Oligohydramnios. [Updated 2025 May 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK562326/
- Blythe C., Vazquez Rez., Cabrera M.S., Zekic Tomas S., Oc Anumba D., Cohen M.C. Results of full postmortem examination in a cohort of clinically unexplained stillbirths: undetected fetal growth restriction and placental insufficiency are prevalent findings. J. Perinatol. 2019; 39(9): 1196-203. https://dx.doi.org/10.1038/s41372-019-0412-z
Received 02.02.2026
Accepted 09.06.2026
About the Authors
Mark A. Kurtser, Academician of the RAS, Dr. Med. Sci., Professor, Head of the Academician G.M. Savelyeva Department of Obstetrics and Gynecology, Institute of Motherhood and Childhood, Pirogov Russian National Research Medical University, Ministry of Health of Russia, 119421, Russia, Moscow, Novatorov str., 3,+7(495)719-78-96, kurtser_ma@rsmu.ru, https://orcid.org/0000-0003-0175-1968
Sergey A. Kalashnikov, Dr. Med. Sci., Professor, Academician G.M. Savelyeva Department of Obstetrics and Gynecology, Institute of Motherhood and Childhood,
Pirogov Russian National Research Medical University, Ministry of Health of Russia, 119421, Russia, Moscow, Novatorov str., 3, +7(495)719-78-96, kalashnikov_sa@rsmu.ru, https://orcid.org/0000-0003-2658-5417
Ksenia Yu. Voskoboeva, PhD student, Academician G.M. Savelyeva Department of Obstetrics and Gynecology, Institute of Motherhood and Childhood, Pirogov Russian National Research Medical University, Ministry of Health of Russia, 119421, Russia, Moscow, Novatorov str., 3, +7(495)719-78-96, voskoboeva96@bk.ru,
https://orcid.org/0000-0003-4484-2229
Corresponding author: Ksenia Yu. Voskoboeva, voskoboeva96@bk.ru
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