Value of perinatal autopsy

Objective: To determine how often a perinatal autopsy identified the cause of death, and how frequently this information changed recurrence risk estim ates or altered parental counseling. Methods: We reviewed all autopsies of fetal stillbirths and briefly viable neonates performed by one perinatal pathologist at the University of Alabam a Hospital from 1992 to 1994. Results: Four hundred sixteen fetal and early neonatal deaths occurred at o ur hospital from January 1, 1992, to June 1, 1994. Consent for an autopsy e xamination was granted for 139 of these (33%), and all autopsies were perfo rmed by a single perinatal pathologist. Abnormalities likely to be the caus e of death were identified in 130 of 139 cases (94%). Ninety-one subjects d id not have structural anomalies: In 14 cases autopsy revealed previously u nsuspected pathology that altered parental counseling; in 68 cases autopsy findings were consistent with the clinical obstetrical diagnosis; and in ni ne cases the cause of death could not be identified. Forty-eight subjects w ere anomalous. Thirty-seven of these (79%) had been evaluated by antenatal ultrasonography, and autopsy identified additional abnormalities in 51% (19 of 37). In the 11 deaths evaluated neonatally, a previously unsuspected di agnosis likely to be the cause of death was identified in three. Overall, a utopsy findings changed recurrence risk estimates and/or parental counselin g in 36 of 139 cases (26%). Conclusion: The cause of fetal or perinatal death was determined by autopsy in 94% of cases in our series. Counseling and recurrence risk estimates we re altered by autopsy findings in 26%. (Obstet Gynecol 1999;94:915-20. (C) 1999 by The American College of Obstetricians and Gynecologists.).