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Differences in Postmortem Investigation following Perinatal Death
Matthew A Nestander1, Kathryn Berryman2, Robert Brady3
1Division of Neonatal, Department of Pediatrics, Carl R. Darnall Army Medical Center, Fort Hood, Texas.
American Journal of Perinatology
|June 14, 2021
Summary
Postmortem investigation rates for perinatal deaths remain low. Stillbirths undergo more thorough investigation, including autopsy and genetic testing, compared to early neonatal deaths, highlighting a need for improved protocols.
Area of Science:
- Perinatal Medicine
- Pathology
- Medical Investigation
Background:
- Perinatal death, encompassing stillbirths and early neonatal deaths, necessitates thorough investigation to determine causes and improve future outcomes.
- Current investigation patterns for perinatal deaths vary, with potential disparities between stillbirths and neonatal deaths.
Purpose of the Study:
- To describe postmortem investigation practices for perinatal deaths.
- To compare the extent of investigation between stillbirths and early neonatal deaths.
Main Methods:
- A single-center retrospective review of perinatal deaths between 2011 and 2017.
- Definition of perinatal death included intrauterine fetal death (≥20 weeks' gestation) and neonatal deaths within the first 7 days of life.
- Comparison of autopsy, postmortem genetic testing, and maternal testing rates between stillbirths and neonatal deaths.
Main Results:
- Of 97 perinatal deaths, 54 were stillbirths and 43 were neonatal deaths.
- Stillbirths were significantly more likely to undergo autopsy (p=0.013) and postmortem genetic testing (p=0.0004) than neonatal deaths.
- 33% of cases lacked postmortem evaluation beyond placental pathology.
Conclusions:
- Investigation following perinatal death is more common in stillbirths than in neonatal deaths.
- Current rates of postmortem investigation for perinatal deaths are low.
- Improved methods for postmortem investigation are needed, especially for neonatal deaths.
