Effectiveness of Superficial Perinatal Post-Mortem Examinations in the Rotunda Hospital from 2000 – 2007
TJ Fitzgerald, JE Gillan. St Vincent's University Hospital, Dublin, Co Dublin, Ireland; Rotunda Hospital, Dublin, Co Dublin, Ireland
Background: Recent years have seen a decline in the perinatal autopsy rate. Reasons for this include reluctance of clinicians to gain consent for post-mortem examinations and refusal of consent by parents. This may be due to the perceived invasive nature of the standard post-mortem. Perinatal post-mortem examinations however, can provide important information both for families and for maintaining standards of care. The superficial post-mortem examination circumvents many parents' major objection to a standard post-mortem. In addition to assessment of gestational age and identification of dysmorphic features, many other characteristics can be evaluated. These include nutritional status, degree of autolysis, pallor, petechiae, traumatic and other iatrogenic lesions. Photographs can be taken for review by a clinical geneticist at a later date. Examination of the placenta can also provide important information, such as evidence of ascending or haematogenous infection. Fibroblasts prepared from placental tissue can be used for cytogenetic investigations.
Design: During the period of the study, superficial examinations were carried out on all perinatal deaths where consent for a full autopsy was refused. The examinations were carried out in a standardised fashion with external measurements entered on a standard form. The placentas were also examined grossly and microscopically with sampling of the fresh placenta for microbiology and cytogenetic studies in selected cases. Post mortem radiology was routinely performed in all cases. Data on these examinations were accumulated from annual clinical reports published by the hospital.
Results: Over the eight-year study period superficial post-mortem examination reached a diagnosis in 130 of 153 cases (85%) in normally formed infants weighing 500g or more, in 188 of 357 cases (53%) less than 500g and in 60 of 66 cases (91%) in infants weighing 500g or more with major malformations. This is in contrast to full post-mortem examinations where a diagnosis was achieved in 217 of 239 cases (91%) 500g or more and 224 of 296 cases (76%) less than 500g.
|Full||Superficial||Superficial - malformation|