Assessing gestational age from histology of fetal skin: an autopsy study of 379 fetuses

doi:10.1016/S0029-7844(99)00379-8

Obstetrics & Gynecology

Volume 94, Issue 5, Part 1, November 1999, Pages 753-757

https://doi.org/10.1016/S0029-7844(99)00379-8 Get rights and content

Abstract

Objective: To develop guidelines for recognizing stages of fetal skin development to allow objective assessment of gestational age.

Methods: Three hundred seventy-nine human fetuses with known gestational ages of 12–30 weeks were examined at autopsy. Skin samples were taken from the abdomen. Two hundred fifty samples constituted a reference to establish histologic criteria from the development of skin appendages, hair, and apocrine and eccrine glands. One hundred twenty-nine additional skin samples were evaluated as a test set by the same investigators without knowledge of the condition of pregnancy or gestational age.

Results: The assessment of 250 skin samples allowed a description of those features that are suddenly discernible and can be used to determine gestational age as having reached or passed weeks 14, 16, 18, 20, 23, 25, and 29 or 30 (after the last menstrual period). Two examiners assessed these histologic features in a random and masked manner in the 129 skin samples of the test set. A 97% agreement with the actual gestational age of the fetus was achieved.

Conclusion: Skin development is a continuous process, but some discrete patterns are strongly related to fetal age, are easy to recognize, and are insensitive to artifacts. In our institution, they have become indispensable in evaluating fetal and neonatal pathology.

Section snippets

Materials and methods

We studied 379 human fetuses at 12–30 weeks’ gestational age. Of these, 250 constituted a reference to establish histologic criteria (Table 1). Gestational age derived from the last menstrual period (LMP) coincided with early ultrasound measurements and developmental indices (especially foot length) at postmortem examination. The causes of abortion or fetal death included intradecidual hemorrhage with abruptio placentae, premature rupture of membranes with chorioamnionitis, and pregnancy

Results

Our evaluation used criteria that were easily recognized and were not sensitive to tilting of the specimens or putrefaction. Embryos up to 9 weeks’ gestation (after the LMP) are covered by a single layer of epidermal cells. From 9 to 13 weeks, two-layered skin is seen with a second, superficial layer called periderm. From 13 weeks on, an intermediate layer is added and fetal skin is stratified, but still does not show appendages. Starting at 14 weeks, the skin of the abdomen shows budding of

Discussion

Development of body shape and organ architecture in human fetuses has been completed largely by 12 weeks’ gestation. However, four organs show major changes in developmental patterns throughout further stages of fetal development. The migration and differentiation of neurons in the brain follow precise timing, but definition of distinctive stages is very difficult from routine examination. The development of the lungs, with branching of the bronchial tree, and development of the kidneys, with

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C.D Urmacher
Normal skin

There are more references available in the full text version of this article.

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Original ArticlesAssessing gestational age from histology of fetal skin: an autopsy study of 379 fetuses

Abstract

Section snippets

Materials and methods

Results

Discussion

The biology of human fetal skin at ages related to prenatal diagnosis

Pediatr Dermatol

Embryology of the hair follicle

Early Hum Dev

Normal skin

Original Articles
Assessing gestational age from histology of fetal skin: an autopsy study of 379 fetuses