Perinatal autopsy reporting practices in Australian stillbirths: a quality review

Stillbirth continues to pose a significant public health challenge. Determining the cause of death is crucial for both prevention and providing closure to families, yet many stillbirths are not adequately investigated. Autopsy and placental assessments are recognised as the gold standard for stillbirth investigation. The utility of these procedures can vary based on the quality of the examination. The aim of this study was to determine the quality of autopsy reporting in Australia in the context of stillbirth. A total of 284 stillbirths with accompanying autopsy reports from 18 maternity hospitals across Australia between 2013 and 2018 were included. Autopsy and placental pathology reports were scored against accepted standards using a modified Vujanic-Khong tool to produce an autopsy quality score (AQS), by a double-blinded panel of assessors to the cause of death. Outcome measures were the number of autopsy reports achieving the score range, with a minimal acceptable score (MAS) of 75%. Reports were assessed based on the type of investigation (full or external), presenting clinical scenario, maceration status, and gestational age. A secondary outcome was to review the format of the autopsy reports. In total, 248 (87%) autopsy reports achieved a MAS, with 166 (58%) of reports achieving 90% of an AQS; 37 (13%) cases did not achieve a MAS, including 14 external examinations, one partial autopsy examination and 23 full autopsy examinations. Full autopsy achieved a higher score than external examinations only. External autopsy examinations were more likely not to have requested medical imaging (59%), cytogenetics (72%), or microbiology (of the placenta, 72%) when thought to be clinically indicated. There was no difference in the MAS according to clinical scenario, gestational age or degree of maceration. There was no consistent autopsy report format in this study. The overall quality of autopsy reports across Australia is high, providing confidence in the use of these reports for classifying a cause of stillbirth. Development of a structured protocol for autopsy reporting to ensure all investigations deemed clinically appropriate are performed and formatting is harmonised across the country is recommended.