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Perinatal death investigations: What is current practice?
J W Nijkamp1, N J Sebire2, K Bouman3
1Department of Obstetrics and Gynecology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Insights
Perinatal death (PD) investigation requires a comprehensive approach, including clinical review, placental examination, and fetal autopsy. This aids in understanding causes and recurrence risks for future pregnancies.
Area of Science:
- Obstetrics and Gynecology
- Perinatal Medicine
- Pathology
Background:
- Perinatal death (PD) is a significant obstetric complication with profound impact on families.
- Understanding the cause of PD is crucial for parental grief, recurrence risk assessment, and future pregnancy management.
Purpose of the Study:
- To outline a systematic diagnostic investigation protocol for perinatal death.
- To emphasize the importance of integrating clinical and investigative findings for accurate causality determination.
Main Methods:
- Detailed review of maternal, obstetric, and current pregnancy history.
- Standard placental examination, molecular cytogenetic evaluation, and fetal autopsy.
- Kleihauer test for fetal-maternal hemorrhage.
- Alternative methods for non-consensual autopsies: minimally invasive examination, postmortem MRI, fetal photography.
Main Results:
- A structured approach to PD investigation yields comprehensive data.
- Integration of clinical review with placental examination, cytogenetics, and autopsy is essential.
- Alternative diagnostic methods can be employed when autopsy is not feasible.
Conclusions:
- A thorough diagnostic investigation is indispensable following a perinatal death.
- Accurate determination of the cause of death facilitates parental counseling and future reproductive planning.
- Multifaceted investigation, including clinical assessment and postmortem examinations, is key to understanding PD.
Abstract:
Perinatal death (PD) is a devastating obstetric complication. Determination of cause of death helps in understanding why and how it occurs, and it is an indispensable aid to parents wanting to understand why their baby died and to determine the recurrence risk and management in subsequent pregnancy. Consequently, a perinatal death requires adequate diagnostic investigation. An important first step in the analysis of PD is to identify the case circumstances, including relevant details regarding maternal history, obstetric history and current pregnancy (complications are evaluated and recorded). In the next step, placental examination is suggested in all cases, together with molecular cytogenetic evaluation and fetal autopsy. Investigation for fetal-maternal hemorrhage by Kleihauer is also recommended as standard. In cases where parents do not consent to autopsy, alternative approaches such as minimally invasive postmortem examination, postmortem magnetic resonance imaging, and fetal photographs are good alternatives. After all investigations have been performed it is important to combine findings from the clinical review and investigations together, to identify the most probable cause of death and counsel the parents regarding their loss.
