Value of the perinatal autopsy: critique

In consenting to a perinatal autopsy, the primary motive of parents may be to find the exact cause of death. A critical review on the value of perinatal autopsies was performed to see whether parents could be counseled regarding their main motive. A literature search was performed in MEDLINE, EXCERPTA MEDICA, and the Cochrane library. We evaluated the value of the autopsy by comparing the clinical and autopsy diagnoses in stillbirths, neonatal deaths, and therapeutic terminations. Clinicopathologic concordance was divided into four categories: (1) change in diagnosis, (2) additional findings, (3) complete confirmation, and (4) inconclusive. We sought information on factors that may influence the value of perinatal autopsies: the type and definitions of perinatal loss; autopsy rate; level of hospital; expertise of pathologists; autopsy protocol used; whether patients were inborn or referred; and antenatal diagnosis. From the 27 articles that met our review criteria, the autopsy revealed a change in diagnosis or additional findings in 22% to 76% of cases. If confirmation of clinical findings is included, then the value of the perinatal autopsy was as high as up to 100%. Factors that could influence this rate were reported variably by investigators. When centers report their experience of the value of the perinatal autopsy, information on the factors that may influence their reports should be provided as well. Clinicians can confidently advise parents of the usefulness of the perinatal autopsy in ascertaining the cause of death or for counseling their future pregnancies.