VALUE AND QUALITY OF PERINATAL AND INFANT POSTMORTEM EXAMINATIONS - COHORT ANALYSIS OF 400 CONSECUTIVE DEATHS

Objectives-To evaluate the contribution that perinatal and infant necr opsy makes to clinical practice and to see how this might be influence d by the quality of the investigation. Design-Cohort analysis, with da ta from the all Wales perinatal survey, of perinatal and infant deaths during 1993 of babies born to mothers usually resident in Wales. The clinicopathological classification of death based on clinical details was compared with the classification after necropsy. Similarly, cases in which necropsy yielded new information were identified. The quality of the necropsy was assessed by scoring six aspects of the examinatio n. Subjects-400 consecutive deaths at 20 weeks of gestation to 1 year of age. Main outcome measures-Necropsy rate, effect of necropsy on cli nicopathological classification, new information disclosed by necropsy , quality of necropsies, and the link between new information and qual ity of the necropsy. Results-Necropsy was performed in 232 cases (58%) . The clinicopathological classification was altered by necropsy in 29 cases (13%). New information was obtained in 60 cases (26%), and in 4 2 (18%) it disclosed the cause of death. The quality of necropsy was s ubstantially higher when the main cause of death was detected than whe n nothing new was found. Conclusion-Necropsy is underused. Clinicians should be more positive about necropsies and realise how much clinical ly relevant information can be obtained from a good quality examinatio n.