Perinatal Autopsy Has Role to Play in Community Hospitals

Norra MacReady

October 24, 2006

October 24, 2006 (Las Vegas) — Perinatal autopsy has fallen out of favor in recent years at community hospitals, but it may still provide information useful for genetic counseling, Abir Mukherjee, MD, said at the annual meeting of the American Society for Clinical Pathology.

Dr. Mukherjee and colleagues retrospectively reviewed autopsies on 118 infants, including 68 stillbirths and 50 neonatal deaths, performed at St. John Hospital in Detroit, Michigan, where Dr. Mukherjee is a resident in pathology. The autopsies took place between January 1998 and July 2005. The investigators excluded fetal deaths occurring at 20 weeks of age or younger, and neonatal deaths that occurred at 28 days of age or older. The autopsy rate remained similar over the years.

The investigators' goal was to examine the correlation of the autopsy findings to prenatal radiographic diagnosis and postmortem karyotyping, Dr. Mukherjee said during an oral presentation of the findings.

The investigators were able to make a conclusive autopsy diagnosis in 86 cases (73%). Congenital malformations were the cause of death in 22 cases (19%), including thanatophoric dysplasia, trisomy 18, Potter phenotype, tetralogy of fallot, and Juene syndrome. In 18% of cases, examination of the placenta contributed significantly to the final diagnosis. Premortem radiology missed the congenital malformations in 15% of the cases.

Postmortem karyotyping was performed in 102 cases, with no growth seen in 38, Dr. Mukherjee said. Anomalies were seen in 4 cases, and the remaining 60 cases were normal.

"We conclude that perinatal autopsy complements the premortem radiological diagnosis," Dr. Mukherjee said, explaining that it can provide additional details that, while minor, could help with genetic counseling. Concurrent examination of the placenta may also be of diagnostic value.

There were some areas of concern in the study, he added. The most important of these were the failures of karyotyping and the high rate of inconclusive autopsy findings. The rate of postmortem karyotyping failures also was high and underscores the importance of antemortem genetic studies.

"Despite these limitations, we feel that perinatal autopsy at a community hospital does yield valuable information," Dr. Mukherjee said.

This study did not receive commercial support. The authors report no relevant financial relationships.

Am J Clin Pathol. 2006;126:630. Abstract 16; presented October 21, 2006.

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