A fetus that shows no signs of life and weighs 1000 g or more is classified as stillborn child.

Maceration (from Latin macerare soften by soaking) includes all the changes which occur in a fetus retained in utero after death.

NYHA FUNCTIONAL CLASS

Functional Capacity Class I. Patients with cardiac disease but without resulting limitation of physical activity. Ordinary physical activity does not cause undue fatigue, palpitation, dyspnea, or anginal pain. Class II. Patients with cardiac disease resulting in slight limitation of physical activity. They are comfortable at rest. Ordinary physical activity results in fatigue, palpitation, dyspnea, or anginal pain. Class III. Patients with cardiac disease resulting in marked limitation of physical activity. They are comfortable at rest. Less than ordinary activity causes fatigue, palpitation, dyspnea, or anginal pain. Class IV. Patients with cardiac disease resulting in inability to carry on any physical activity without discomfort. Symptoms of heart failure or the anginal syndrome may be present even at rest. If any physical activity is undertaken, discomfort is increased. Objective Assessment A. No objective evidence of cardiovascular disease. B. Objective evidence of minimal cardiovascular disease. C. Objective evidence of moderately severe cardiovascular disease. D. Objective evidence of severe cardiovascular disease.

1. 2.

Mors fetus intrauterina fetal demise during pregnancy, usually shows maceration Mors fetus intrapartum death occurs during delivery, fresh stillborn fetus

Estimating the time of death in stillborn fetus

Desquamated skin measuring 1 cm or more in diameter and red or brown discoloration of the umbilical cord correlated with fetal death 6 or more hours before birth. Dequamation involving the skin of face, back or abdomen (12 or more hours) Desquamation of 5% or more of the body surface (18 or more hours) Moderate to severe desquamation, brown skin discoloration of the abdomen (24 or more hours) Mummification is seen in fetuses who had died 2 or more weeks before birth

Bullae in epidermis (leading to peeling): appear at about 24 hours Hemoglobin staining of internal viscera (loss of normal color): 24-48 hours Separation of dura from calvarium bone: 5+ days Grade of Features Maceration 0 I II "parboiled" reddened skin skin slippage and peeling Duration of Intrauterine Demise < 8 hours > 8 hours

Examples of patient classification: 1. Dyspnea at rest and a near total occlusion of the left main coronary artery: Functional Capacity IV, Objective Assessment D. 2. Mild dyspnea while climbing stairs and a severe aortic stenosis: Functional Capacity II, Objective Assessment D. 3. Angina at rest and angiographically normal coronary arteries: Functional Capacity IV, Objective Assessment A. 4. No cardiac symptoms and a moderate pressure gradient across the mitral valve: Functional Capacity I, Objective Assessment C.

extensive skin peeling 2-7 days red serous effusions in chest and abdomen due to hemoglobin staining liver yellow-brown turbid effusion may be mummified >= 8 days

III

PERASAT OSBORN Teknik:

1. 2. 3. 4.

Pasien terlentang, tungkai sedikit fleksi. Kepala janin dipegang oleh tangan kiri pemeriksa. 2 jari lain diatas simfisis, permukaan jani berada pada permukaan anterior dari simfisis.

Tentukan derajat tumpang tindih ketika kepala janin ditekan ke bawah dan ke belakang. Interpretasi: 1. CPD (-): kepala dapat ditekan ke dalam panggul, tidak terdapat tumpang tindih dari os parietal. 2. CPD sedang: kepala dapat ditekan sedikit, terdapat sedikit tumpang tindih dari os parietal, sekitar 0,5cm lanjut perasat Muller. 3. CPD(+): kepala tidak dapat dimasukkan ke dalam tulang panggul, tulang parietal menggantung di atas simfisis dengan dibatasi jari. PERASAT MULLER Teknik: 1. Pasien terlentang, tungkai sedikit fleksi. 2. 1 tangan memegang kepala dari luar di atas simfisis. 3. 2jari dari tangan yg lain masuk ke dalam vagina, sampai PAP. 4. Tangan luar mendorong kepala bayi ke arah simfisis. Interpretasi: 1. CDP (-): kepala bayi teraba oleh kedua jari. 2. CPD(+): kepala bayi tidak teraba oleh kedua jari.