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DOI: 10.1055/s-0039-1681013
How does Fetal Autopsy after Pregnancy Loss or Termination for Anomalies and other Complications Change Recurrence Risk?
Funding Sources Author A.C. was supported by the UCSF Dean's Office Medical Student Research Program.Publication History
16 October 2018
19 October 2018
Publication Date:
18 February 2019 (online)
Abstract
Objective Historically, fetal autopsy was common after terminations for anomalies. Previous studies report that fetal autopsy confirms ultrasound findings in the majority of cases. This study aims to examine correlation between prenatal and autopsy diagnoses at University of California, San Francisco (UCSF) and evaluate whether autopsy adds diagnostic information, specifically information that changes risk of recurrence for future pregnancies.
Study Design We conducted a retrospective chart review of all fetal autopsies performed at UCSF between 1994 and 2009. Prenatal diagnosis was compared with autopsy diagnosis; for cases where there was a change in diagnosis, an MFM (maternal-fetal medicine specialist) reviewed the case to assign risk of recurrence before and after autopsy.
Results Overall, there was concordance between prenatal diagnosis and autopsy diagnosis in greater than 91.7% of cases. Autopsy added information that resulted in a change in recurrence risk in 2.3% of cases (n = 9).
Conclusion For the vast majority of cases, there is agreement between prenatal and autopsy diagnosis after pregnancy loss or termination for fetal anomalies. Only a small percentage of autopsies change recurrence risk. This may be useful when counseling women about method of termination and when counseling couples about whether to have an autopsy.
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References
- 1 ACOG Practice Bulletin No. ACOG practice bulletin no. 102: management of stillbirth. Obstet Gynecol 2009; 113 (03) 748-761
- 2 Boyd PA, Tondi F, Hicks NR, Chamberlain PF. Autopsy after termination of pregnancy for fetal anomaly: retrospective cohort study. BMJ 2004; 328 (7432): 137
- 3 Dickinson JE, Prime DK, Charles AK. The role of autopsy following pregnancy termination for fetal abnormality. Aust N Z J Obstet Gynaecol 2007; 47 (06) 445-449
- 4 Picone O, Levaillant J-M, Hirt R, Frydman R, Boulvain M, Senat M-V. Correlation between referral ultrasound with suspected foetal anomalies and autopsy examination in two prenatal diagnosis centres. Impact of the routine use of 3D/4D scan. Prenat Diagn 2008; 28 (03) 191-196
- 5 Parkar AP, Olsen ØE, Maartmann-Moe H, Daltveit AK, Gjelland K, Rosendahl K. Antenatal ultrasound and postnatal autopsy findings in terminations after 12 weeks' gestation due to fetal abnormality: population-based study in Western Norway, 1988-2002. Acta Radiol 2009; 50 (07) 816-822
- 6 Akgun H, Basbug M, Ozgun MT. , et al. Correlation between prenatal ultrasound and fetal autopsy findings in fetal anomalies terminated in the second trimester. Prenat Diagn 2007; 27 (05) 457-462
- 7 Amini H, Antonsson P, Papadogiannakis N. , et al. Comparison of ultrasound and autopsy findings in pregnancies terminated due to fetal anomalies. Acta Obstet Gynecol Scand 2006; 85 (10) 1208-1216
- 8 Antonsson P, Sundberg A, Kublickas M. , et al. Correlation between ultrasound and autopsy findings after 2nd trimester terminations of pregnancy. J Perinat Med 2008; 36 (01) 59-69
- 9 Isaksen CV, Eik-Nes SH, Blaas HG, Torp SH. Comparison of prenatal ultrasound and postmortem findings in fetuses and infants with central nervous system anomalies. Ultrasound Obstet Gynecol 1998; 11 (04) 246-253
- 10 Isaksen CV, Eik-Nes SH, Blaas HG, Tegnander E, Torp SH. Comparison of prenatal ultrasound and postmortem findings in fetuses and infants with congenital heart defects. Ultrasound Obstet Gynecol 1999; 13 (02) 117-126
- 11 Johns N, Al-Salti W, Cox P, Kilby MD. A comparative study of prenatal ultrasound findings and post-mortem examination in a tertiary referral centre. Prenat Diagn 2004; 24 (05) 339-346
- 12 Kaasen A, Tuveng J, Heiberg A, Scott H, Haugen G. Correlation between prenatal ultrasound and autopsy findings: a study of second-trimester abortions. Ultrasound Obstet Gynecol 2006; 28 (07) 925-933
- 13 Stubblefield PG, Carr-Ellis S, Borgatta L. Methods for induced abortion. Obstet Gynecol 2004; 104 (01) 174-185
- 14 Sun CC, Grumbach K, DeCosta DT, Meyers CM, Dungan JS. Correlation of prenatal ultrasound diagnosis and pathologic findings in fetal anomalies. Pediatr Dev Pathol 1999; 2 (02) 131-142
- 15 Grimes DA, Smith MS, Witham AD. Mifepristone and misoprostol versus dilation and evacuation for midtrimester abortion: a pilot randomised controlled trial. BJOG 2004; 111 (02) 148-153
- 16 Piercecchi-Marti MD, Liprandi A, Sigaudy S. , et al. Value of fetal autopsy after medical termination of pregnancy. Forensic Sci Int 2004; 144 (01) 7-10
- 17 Godbole K, Bhide V, Nerune S, Kulkarni A, Moghe M, Kanade A. Role of fetal autopsy as a complementary tool to prenatal ultrasound. J Matern Fetal Neonatal Med 2014; 27 (16) 1688-1692
- 18 Rodriguez MA, Prats P, Rodríguez I, Cusí V, Comas C. Concordance between prenatal ultrasound and autopsy findings in a tertiary center. Prenat Diagn 2014; 34 (08) 784-789
- 19 Thayyil S, Sebire NJ, Chitty LS. , et al; MARIAS collaborative group. Post-mortem MRI versus conventional autopsy in fetuses and children: a prospective validation study. Lancet 2013; 382 (9888): 223-233
- 20 Arthurs OJ, Thayyil S, Pauliah SS. , et al; Magnetic Resonance Imaging Autopsy Study (MaRIAS) Collaborative Group. Diagnostic accuracy and limitations of post-mortem MRI for neurological abnormalities in fetuses and children. Clin Radiol 2015; 70 (08) 872-880
- 21 Cohen MC, Paley MN, Griffiths PD, Whitby EH. Less invasive autopsy: benefits and limitations of the use of magnetic resonance imaging in the perinatal postmortem. Pediatr Dev Pathol 2008; 11 (01) 1-9
- 22 Griffiths PD, Variend D, Evans M. , et al. Postmortem MR imaging of the fetal and stillborn central nervous system. AJNR Am J Neuroradiol 2003; 24 (01) 22-27
- 23 Cannie M, Votino C, Moerman P. , et al. Acceptance, reliability and confidence of diagnosis of fetal and neonatal virtuopsy compared with conventional autopsy: a prospective study. Ultrasound Obstet Gynecol 2012; 39 (06) 659-665
- 24 Boecking CA, Drey EA, Kerns JL, Finkbeiner WE. Correlation of prenatal diagnosis and pathology findings following dilation and evacuation for fetal anomalies. Arch Pathol Lab Med 2017; 141 (02) 267-273