Clinical experience of a fetal postmortem imaging service using microfocus computed tomography

Area of Science:

• Medical Imaging
• Pathology
• Perinatal Medicine

Background:

• Postmortem imaging is increasingly accepted for perinatal autopsies, especially for early gestation or small fetuses where conventional methods are challenging.
• Parental consent for conventional autopsies can be a barrier in perinatal cases.

Purpose of the Study:

• To determine the diagnostic yield of microfocus computed tomography (MCT) as part of less invasive perinatal autopsies.
• To evaluate MCT's effectiveness in fetuses under 24 weeks of gestation.

Main Methods:

• A retrospective study of 1007 perinatal autopsies over 7 years (2016-2023) involving fetuses weighing less than 300g.
• Microfocus computed tomography (MCT) was offered as an option for all eligible fetuses, with informed parental consent.
• Data included external examination, placental assessment, and MCT findings.

Main Results:

• A diagnosis was reached in 51.1% of cases, with fetal causes in 21.1% and placental causes in 26.2%.
• Microfocus computed tomography (MCT) enabled diagnosis in 59.4% of cases, with higher rates in miscarriage and termination of pregnancy.
• Only 43 fetuses (4.3%) required an invasive autopsy, achieving a 95.7% autopsy avoidance rate.

Conclusions:

• Combining external examination, placental assessment, and microfocus computed tomography (MCT) achieves diagnoses in over 50% of early gestation fetuses.
• This less invasive approach provides diagnoses within 3 weeks and maintains a high autopsy avoidance rate, aligning with parental preferences.