New Page on Pancreas

I have added the pancreas to the autopsy manual. My resources for creating these pages is currently limited. I am more than willing to have colleagues add their knowledge and suggestions to these pages by emailing me. I am posting the autopsy manual as a basis to develop a shared autopsy protocol for the stillborn research project (see research menu). Some conditions that cause perinatal death of liveborn infants, such as fetal hydrops, oligohydramnios and fetal growth restriction, also increase the risk of stillbirth. The manual considers findings and causes in these conditions, although briefly. The manual also does not develop an integrated picture of disease. I plan for the regular obstetrical pathology pages to accomplish that goal such as pages on maternal diabetes, macrosomia and the mechanisms of fetal growth restriction. 

            The stillbirth research protocol will include in situ MRI of the umbilical cord in fetal death, and a clinical history that looks in more detail at immediate factors that might in aggregate compromise the fetus and lead to a positive feedback loop that causes hypoxic or acidotic death. The primary goal of the study is to improve understanding and hopefully prevention of stillbirth of currently unknown cause. However, as in any perinatal autopsy, there is the hope that more general knowledge of intrauterine disease will also be found, such as insight into how intrauterine factors cause adult disease or how sublethal events might lead to or predispose to permanent neurologic injury. For an example of the former, I recall Dr. Mike Ross presenting at a NICHD Diabetes in Pregnancy meeting data on a rat model of maternal hyperglycemia that seemed to change the satiety response of the offspring. He presented slides showing associated brain abnormalities in the arcuate and related hypothalamic nuclei. I could not find a publication cite for this work, but if the results held, it would be possible to prospectively look for similar brain changes at autopsy of infants of diabetic mothers.