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Am J Perinatol 2023; 40(07): 780-787
DOI: 10.1055/s-0041-1731276
Original Article

Differences in Postmortem Investigation following Perinatal Death

Matthew A. Nestander
1   Division of Neonatal, Department of Pediatrics, Carl R. Darnall Army Medical Center, Fort Hood, Texas
,
Kathryn Berryman
2   Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, Brooke Army Medical Center, Fort Sam Houston, Texas
,
Robert Brady
3   Department of Pathology, Brooke Army Medical Center, Fort Sam Houston, Texas
,
James Aden
4   Department of Graduate Medical Education, Brooke Army Medical Center, Fort Sam Houston, Texas
,
Gayle Haischer-Rollo
5   Department of Pediatrics, Neonatal Division, Brooke Army Medical Center, Fort Sam Houston, Texas
› Author Affiliations Funding None.
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Abstract

Objective The study aimed to describe the postmortem investigation patterns for perinatal deaths and compare the degree of investigation between stillbirths and early neonatal deaths.

Study Design We conducted a single-center retrospective review of all perinatal deaths from 2011 to 2017. Perinatal death was defined as intrauterine fetal death at ≥20 weeks' gestation, plus neonatal deaths within the first 7 days of life. Rates of postmortem investigation were compared.

Results There were 97 perinatal deaths, with 54 stillbirths (56%) and 43 neonatal deaths (44%). Stillbirths were significantly more likely to receive autopsy (p = 0.013) and postmortem genetic testing (p = 0.0004) when compared with neonatal deaths. Maternal testing was also more likely in stillbirths than neonatal deaths. A total of 32 deaths (33%) had no postmortem evaluation beyond placental pathology.

Conclusion Investigation following perinatal death is more likely in stillbirths than neonatal deaths. Methods to improve postmortem investigation following perinatal death are needed, particularly for neonatal deaths.

Key Points

  • Investigation into perinatal death is recommended.

  • Rates of investigation remain low.

  • Neonatal deaths with less investigation than stillbirths.

Keywords

perinatal death - autopsy - stillbirth

Authors' Contributions

M.A.N. conceptualized study, collected data, and drafted the initial manuscript. K.B. and R.B. helped formulate the methods, reviewed the data, supervised data collection, and interpreted the results. J.A. provided statistical expertise and data review. G.H.R. reviewed the protocol and assisted with data collection. All authors edited the manuscript and approved the final manuscript as submitted. All authors agree to be accountable for all aspects of the work.


Note

The appropriate institutional review board approved this study. This study was performed in accordance with the Declaration of Helsinki.




Publication History

Received: 01 December 2020

Accepted: 10 May 2021

Article published online:
14 June 2021

© 2021. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 MacDorman MF, Gregory EC. Fetal and perinatal mortality: United States, 2013. Natl Vital Stat Rep 2015; 64 (08) 1-24
    PubMedSearch in Google Scholar
  • 2 Gregory ECW, Drake P, Martin JA. Lack of change in perinatal mortality in the United States, 2014-2016. NCHS Data Brief 2018; (316) 1-8
    PubMedSearch in Google Scholar
  • 3 Flenady V, Wojcieszek AM, Middleton P. et al; Lancet Ending Preventable Stillbirths study group, Lancet Stillbirths In High-Income Countries Investigator Group. Stillbirths: recall to action in high-income countries. Lancet 2016; 387 (10019): 691-702
    CrossrefPubMedSearch in Google Scholar
  • 4 Barfield WD. Committee on Fetus and Newborn. Standard terminology for fetal, infant, and perinatal deaths. Pediatrics 2011; 128 (01) 177-181
    CrossrefPubMedSearch in Google Scholar
  • 5 Ely DM, Driscoll AK, Mathews TJ. Infant mortality by age at death in the United States. 2016. NCHS Data Brief, no 326: 1-8. Hyattsville, MD: National Center for Health Statistics; 2018
    Search in Google Scholar
  • 6 Hoyert DL, Gregory EC. Cause of fetal death: data from the fetal death report, 2014. Natl Vital Stat Rep 2016; 65 (07) 1-25
    PubMedSearch in Google Scholar
  • 7 Norris T, Manktelow BN, Smith LK, Draper ES. Causes and temporal changes in nationally collected stillbirth audit data in high-resource settings. Semin Fetal Neonatal Med 2017; 22 (03) 118-128
    CrossrefPubMedSearch in Google Scholar
  • 8 Flenady V, Wojcieszek AM, Ellwood D. et al; International Stillbirth Alliance Collaborative for Improving Classification of Perinatal Deaths. Classification of causes and associated conditions for stillbirths and neonatal deaths. Semin Fetal Neonatal Med 2017; 22 (03) 176-185
    CrossrefPubMedSearch in Google Scholar
  • 9 ACOG. Bulletins—Obstetrics ACoP Management of stillbirth. ACOG practice bulletin no 102. Obstet Gynecol 2009; 113 (03) 748-761
    PubMedSearch in Google Scholar
  • 10 Kilpatrick S, Papile L, Macones G. Guidelines for Perinatal Care, 8th Edition. American Academy of Pediatrics and American College of Obstetricians and Gynecologists. 2017
    Search in Google Scholar
  • 11 Auger N, Bilodeau-Bertrand M, Poissant J, Shah PS. Decreasing use of autopsy for stillbirths and infant deaths: missed opportunity. J Perinatol 2018; 38 (10) 1414-1419
    CrossrefPubMedSearch in Google Scholar
  • 12 Blythe C, Vazquez REZ, Cabrera MS, Zekic Tomas S, Oc Anumba D, Cohen MC. Results of full postmortem examination in a cohort of clinically unexplained stillbirths: undetected fetal growth restriction and placental insufficiency are prevalent findings. J Perinatol 2019; 39 (09) 1196-1203
    CrossrefPubMedSearch in Google Scholar
  • 13 James D. Improving the uptake of prenatal, perinatal and paediatric autopsies. BJOG 2019; 126 (06) 754
    CrossrefPubMedSearch in Google Scholar
  • 14 Wimmer LJ, Storey C, Silver R. Improving postmortem testing for perinatal death from the parents' perspective. BJOG 2018; 125 (02) 182
    CrossrefPubMedSearch in Google Scholar
  • 15 Lewis C, Hill M, Arthurs OJ, Hutchinson JC, Chitty LS, Sebire N. Health professionals' and coroners' views on less invasive perinatal and paediatric autopsy: a qualitative study. Arch Dis Child 2018; 103 (06) 572-578
    CrossrefPubMedSearch in Google Scholar
  • 16 Arthurs OJ, Bevan C, Sebire NJ. Less invasive investigation of perinatal death. BMJ 2015; 351: h3598
    CrossrefPubMedSearch in Google Scholar
  • 17 Sonnemans LJP, Vester MEM, Kolsteren EEM. et al; Dutch post-mortem imaging guideline group. Dutch guideline for clinical foetal-neonatal and paediatric post-mortem radiology, including a review of literature. Eur J Pediatr 2018; 177 (06) 791-803
    CrossrefPubMedSearch in Google Scholar
  • 18 Shamseldin HE, Kurdi W, Almusafri F. et al. Molecular autopsy in maternal-fetal medicine. Genet Med 2018; 20 (04) 420-427
    CrossrefPubMedSearch in Google Scholar
  • 19 Nijkamp JW, Sebire NJ, Bouman K, Korteweg FJ, Erwich JJHM, Gordijn SJ. Perinatal death investigations: what is current practice?. Semin Fetal Neonatal Med 2017; 22 (03) 167-175
    CrossrefPubMedSearch in Google Scholar
  • 20 de Sévaux JLH, Nikkels PGJ, Lequin MH, Groenendaal F. The value of autopsy in neonates in the 21st century. Neonatology 2019; 115 (01) 89-93
    CrossrefPubMedSearch in Google Scholar
  • 21 Blokker BM, Weustink AC, Hunink MGM, Oosterhuis JW. Autopsy rates in the Netherlands: 35 years of decline. PLoS One 2017; 12 (06) e0178200
    CrossrefPubMedSearch in Google Scholar
  • 22 Lewis C, Hill M, Arthurs OJ, Hutchinson C, Chitty LS, Sebire NJ. Factors affecting uptake of postmortem examination in the prenatal, perinatal and paediatric setting. BJOG 2018; 125 (02) 172-181
    CrossrefPubMedSearch in Google Scholar
  • 23 Bakhbakhi D, Burden C, Storey C, Siassakos D. Care following stillbirth in high-resource settings: latest evidence, guidelines, and best practice points. Semin Fetal Neonatal Med 2017; 22 (03) 161-166
    CrossrefPubMedSearch in Google Scholar
  • 24 Peters MD, Lisy K, Riitano D, Jordan Z, Aromataris E. Providing meaningful care for families experiencing stillbirth: a meta-synthesis of qualitative evidence. J Perinatol 2016; 36 (01) 3-9
    CrossrefPubMedSearch in Google Scholar
  • 25 Gardiner PA, Kent AL, Rodriguez V. et al. Evaluation of an international educational programme for health care professionals on best practice in the management of a perinatal death: IMproving Perinatal mortality Review and Outcomes Via Education (IMPROVE). BMC Pregnancy Childbirth 2016; 16 (01) 376
    CrossrefPubMedSearch in Google Scholar
  • 26 Meaney S, Gallagher S, Lutomski JE, O'Donoghue K. Parental decision making around perinatal autopsy: a qualitative investigation. Health Expect 2015; 18 (06) 3160-3171
    CrossrefPubMedSearch in Google Scholar
  • 27 Lavista Ferres JM, Anderson TM, Johnston R, Ramirez JM, Mitchell EA. Distinct populations of sudden unexpected infant death based on age. Pediatrics 2020; 145 (01) e20191637
    CrossrefPubMedSearch in Google Scholar
  • 28 Goldstein RD. Sudden unexplained infant deaths and day of life 0. Pediatrics 2020; 145 (01) e20193212
    CrossrefPubMedSearch in Google Scholar
  • 29 Page JM, Christiansen-Lindquist L, Thorsten V. et al. Diagnostic tests for evaluation of stillbirth: results from the stillbirth collaborative research network. Obstet Gynecol 2017; 129 (04) 699-706
    CrossrefPubMedSearch in Google Scholar
  • 30 Adappa R, Paranjothy S, Roberts Z, Cartlidge PH. Perinatal and infant autopsy. Arch Dis Child Fetal Neonatal Ed 2007; 92 (01) F49-F50
    CrossrefPubMedSearch in Google Scholar
  • 31 Brodlie M, Laing IA, Keeling JW, McKenzie KJ. Ten years of neonatal autopsies in tertiary referral centre: retrospective study. BMJ 2002; 324 (7340): 761-763
    CrossrefPubMedSearch in Google Scholar
  • 32 Khong TY. Falling neonatal autopsy rates. BMJ 2002; 324 (7340): 749-750
    CrossrefPubMedSearch in Google Scholar
  • 33 Heazell AE, McLaughlin MJ, Schmidt EB. et al. A difficult conversation? The views and experiences of parents and professionals on the consent process for perinatal postmortem after stillbirth. BJOG 2012; 119 (08) 987-997
    CrossrefPubMedSearch in Google Scholar
  • 34 Henderson J, Redshaw M. Parents' experience of perinatal post-mortem following stillbirth: a mixed methods study. PLoS One 2017; 12 (06) e0178475
    CrossrefPubMedSearch in Google Scholar
  • 35 Horey D, Flenady V, Conway L, McLeod E, Yee Khong T. Decision influences and aftermath: parents, stillbirth and autopsy. Health Expect 2014; 17 (04) 534-544
    CrossrefPubMedSearch in Google Scholar
  • 36 Khong TY. Improving perinatal autopsy rates: who is counseling bereaved parents for autopsy consent?. Birth 1997; 24 (01) 55-57
    CrossrefPubMedSearch in Google Scholar
  • 37 Rüegger CM, Bartsch C, Martinez RM. et al. Minimally invasive, imaging guided virtual autopsy compared to conventional autopsy in foetal, newborn and infant cases: study protocol for the paediatric virtual autopsy trial. BMC Pediatr 2014; 14 (15) 15
    CrossrefPubMedSearch in Google Scholar
  • 38 Ben-Sasi K, Chitty LS, Franck LS. et al. Acceptability of a minimally invasive perinatal/paediatric autopsy: healthcare professionals' views and implications for practice. Prenat Diagn 2013; 33 (04) 307-312
    CrossrefPubMedSearch in Google Scholar
  • 39 Hutchinson JC, Arthurs OJ, Sebire NJ. Postmortem research: innovations and future directions for the perinatal and paediatric autopsy. Arch Dis Child Educ Pract Ed 2016; 101 (01) 54-56
    CrossrefPubMedSearch in Google Scholar
  • 40 Ahmad MU, Sharif KA, Qayyum H. et al. Assessing the use of magnetic resonance imaging virtopsy as an alternative to autopsy: a systematic review and meta-analysis. Postgrad Med J 2017; 93 (1105): 671-678
    CrossrefPubMedSearch in Google Scholar
  • 41 Arthurs OJ, Hutchinson JC, Sebire NJ. Current issues in postmortem imaging of perinatal and forensic childhood deaths. Forensic Sci Med Pathol 2017; 13 (01) 58-66
    CrossrefPubMedSearch in Google Scholar
  • 42 Dhillon RK, Hillman SC, Morris RK. et al. Additional information from chromosomal microarray analysis (CMA) over conventional karyotyping when diagnosing chromosomal abnormalities in miscarriage: a systematic review and meta-analysis. BJOG 2014; 121 (01) 11-21
    CrossrefPubMedSearch in Google Scholar
  • 43 Wojcik MH, Brodsky D, Stewart JE, Picker J. Peri-mortem evaluation of infants who die without a diagnosis: focus on advances in genomic technology. J Perinatol 2018; 38 (09) 1125-1134
    CrossrefPubMedSearch in Google Scholar
  • 44 Rose C, Evans M, Tooley J. Falling rates of perinatal postmortem examination: are we to blame?. Arch Dis Child Fetal Neonatal Ed 2006; 91 (06) F465
    CrossrefPubMedSearch in Google Scholar
  • 45 Spierson H, Kamupira S, Storey C, Heazell AEP. Professionals' practices and views regarding neonatal postmortem: can we improve consent rates by improving training?. Neonatology 2019; 115 (04) 341-345
    CrossrefPubMedSearch in Google Scholar