WISSP - RADIOGRAPHS

CLINICAL EXAMINATION DEMONSTRATION

About 20% of unselected stillborns will have radiographic abnormalities (and in a smaller proportion they will prove to be critical for diagnosis). While x-rays are most critical in dwarfing conditions etc., unexpected positive findings in other infants whom we have evaluated suggest that all stillborns should have x-ray studies done.

Because of the number of types of machines used, and the need for individual calibration, we can not make specific recommendations for technique. Settings appropriate for a living premature infant of comparable size should result in technically adequate films.

Positioning And Views To Be Taken:

1. Every stillborn should have one AP 'babygram'. The infant should be positioned so that the trunk is as truly AP as possible. The head should be turned to the side (true lateral of the head). The limbs should be straightened as much as possible and, if possible, placed in the 'anatomic' position (resulting in AP views of both the arms and the legs). Head and all limbs, including the hands and feet, should be included:

Quite nice detail can be obtained even on rather tiny stillborns:

If structural abnormalities of the limbs are present, separate films should be taken of the abnormal parts.

If the stillborn is obviously dwarfed, short limbed, has an obvious skeletal dysplasia, etc., additional, more detailed films will be helpful:

AP and lateral of all limbs
AP of the hands
Lateral spine

Here is an example of a radiograph that allows for definitive diagnosis. The crumpled long bones and beaded ribs are diagnostic of osteogenesis imperfecta type II: