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Postnatal water immersion after perinatal death: a clinical study of appearance preservation and autopsy validity
Teresa Starrach1, Jens H L Neumann2, Lucia Ehmann3
1Department of Obstetrics and Gynecology, LMU University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany. Teresa.starrach@med.uni-muenchen.de.
Objective:
Perinatal loss is an emotionally devastating event for affected families. In some clinical settings, postnatal immersion of perinatally deceased infants in water is used to preserve the infant's external appearance and facilitate parental farewell. The objective of this study was to evaluate possible effects of this practice on autopsy findings and diagnostic validity.
Methods:
In this observational study, 28 infants after perinatal death with available autopsy data were analyzed. Fourteen infants were immersed in cold water after birth (water group) and fourteen infants were stored without water immersion (control group). Macroscopic appearance, degree of maceration, and microscopic findings in liver and lung tissue were assessed during autopsy. Descriptive analyses explored associations between maceration degree and the intervals between fetal death, birth, and autopsy.
Results:
Infants immersed in water showed improved preservation of external appearance, including skin color, texture, and body posture. No macroscopic differences attributable to water immersion were observed during autopsy. No microscopic differences in the two investigated internal organs were observed between the water and control groups. Maceration grade assessed at autopsy showed no consistent increase with longer birth-autopsy intervals, whereas higher grades were more frequently observed with longer estimated intervals between fetal death and birth in both groups.
Conclusion:
In this observational cohort, postnatal immersion in water after perinatal death was not associated with impaired autopsy findings. Maceration was primarily related to the intrauterine interval between fetal death and delivery rather than postnatal storage conditions. These findings suggest that the water method may offer a simple approach to support parental farewell while maintaining the diagnostic reliability of perinatal autopsy.
Trial Registration:
Clinical Trials Register (DRKS) (trial registration number DRKS00031373, URL https://www.drks.de ), Registration Date: 27 February 2023.
