The Perinatal Necropsy

  • Jean W. Keeling


The importance to clinical practice of information obtained by adequate necropsy examination of babies dying in the perinatal and neonatal periods (Alberman 1980) is often not fully appreciated by histopathologists providing a biopsy-orientated service for adult patients. Examination of stillborn infants has been particularly neglected. This is probably related both to the unattractive nature of the material and to negative expectations concerning the likelihood of being able to make specific diagnoses.


Neonatal Death Perinatal Death Fetal Organ Necropsy Examination Costochondral Junction 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Alberman E (1980) Prospects for better perinatal health. Lancet 1:189–192PubMedCrossRefGoogle Scholar
  2. Alberman ED, Creasy MR (1977) Frequency of chromosomal abnormalities in miscarriages and perinatal deaths. J Med Genet 14:313–315PubMedCrossRefGoogle Scholar
  3. Alonso K, Portman E (1995) Fetal weights and measurements as determined by postmortem examination and their correlation with ultrasound examination. Arch Pathol Lab Med 119:179–180PubMedGoogle Scholar
  4. Barson AJ (1981) The perinatal postmortem. In: Barson AJ (ed) Laboratory investigation of fetal disease. Wright, Bristol, pp 476–497Google Scholar
  5. Barson AJ (1990) A postmortem study of infection in the newborn from 1976 to 1988. In: de Louvois J, Harvey D (eds) Infection in the newborn. Wiley, Chichester, pp 13–14Google Scholar
  6. Benson PF, Fensom AH (1985) Genetic biochemical disorders. Oxford monographs on medical genetics No 12. Oxford University Press, OxfordGoogle Scholar
  7. Berry CL (1980) The examination of embryonic and fetal material in diagnostic histopathology laboratories. J Clin Pathol 33:317–326PubMedCrossRefGoogle Scholar
  8. Billson V, Masterton RG, Keeling JW (1993) How useful is postmortem bacteriological investigation? J Pathol 169 suppl 120 AGoogle Scholar
  9. Blanc WA (1981) Pathology of the placenta, membranes and umbilical cord in bacterial, fungal and viral infections in man. In: Naeye RK, Kissane JM, Kaufman N (eds) Perinatal disease. Williams & Wilkins, Baltimore, pp 67–132Google Scholar
  10. Bove KE (1997) Practice guidelines for autopsy pathology: the perinatal and pediatric autopsy. Autopsy committee of the College of American Pathologists. Arch Pathol Lab Med 121:368–376PubMedGoogle Scholar
  11. Boyd PA, Brown RA, Stewart WJ (1980) Quantitative structural differences within the normal term human placenta; a pilot study. Placenta 1:337–344PubMedCrossRefGoogle Scholar
  12. Brookes JAS, Hall-Craggs MA, Sams VR, Lees WR (1996) Noninvasive perinatal necropsy by magnetic resonance imaging. Lancet 1:1139–1141CrossRefGoogle Scholar
  13. Campbell S, Pearce JMF (1985) Ultrasound in obstetrics and gynaecology. In: Mcdonald RR (ed) Scientific basis of obstetrics and gynaecology. Churchill Livingstone, Edinburgh, pp 304–349Google Scholar
  14. Cartlidge PHT, Dawson AT, Stewart JH, Vujanic GM (1995) Value and quality of perinatal and infant postmortem examinations: cohort analysis of 400 consecutive deaths. Br Med J 310:155–158CrossRefGoogle Scholar
  15. Chamberlain GVP (1985) The length of labour. In: Crawford JW (ed) Risks of labour. Wiley, Chichester, pp 1–10Google Scholar
  16. Chambers HM (1992) The perinatal autopsy: a contemporary approach. Pathology 24:45–55PubMedCrossRefGoogle Scholar
  17. Cooke RWI, Lucas A, Yudkin PLN, Pryse-Davies J (1977) Head circumference as an index of brain weight in the fetus and newborn. Early Hum Dev 1:145–149PubMedCrossRefGoogle Scholar
  18. Dorovini-Zis K, Dolman CL (1977) Gestational development of brain. Arch Pathol Lab Med 101:192–195PubMedGoogle Scholar
  19. Emery JL, Kalpaktsoglou PK (1967) The costochondral junction during later stages of intrauterine life, and abnormal growth patterns found in association with perinatal death. Arch Dis Child 42:1–13PubMedCrossRefGoogle Scholar
  20. Foote GA, Wilson AJ, Stewart JH (1978) Perinatal postmortem radiography-experience with 2500 cases. Br J Radiol 51:351–356PubMedCrossRefGoogle Scholar
  21. Furness ME, Weckert RC, Parker SA, Knowles S (1989) Ultrasound in the perinatal necropsy. J Med Genet 26:368–372PubMedCrossRefGoogle Scholar
  22. Gairdner D, Pearson J (1971) A growth chart for premature and other infants. Arch Dis Child 46:783–794PubMedCrossRefGoogle Scholar
  23. Gatzoulis MA, Sheppard MN, Ho SY (1996) Value and impact of necropsy in paediatric cardiology. Heart 75(6):626–31PubMedCrossRefGoogle Scholar
  24. Gau G. The ultimate audit. Br Med J 1977:1580–2Google Scholar
  25. Gruenwald P, Minh HN (1960) Evaluation of body and organ weights in perinatal pathology. I. Normal standards derived from autopsies. Am J Clin Pathol 34:247–253PubMedGoogle Scholar
  26. Gruenwald P, Minh HN (1961) Evaluation of body and organ weights in perinatal pathology. II. Weight of body and placenta of surviving and of autopsied infants. Am J Obstet Gynecol 82:312–319PubMedGoogle Scholar
  27. Hawass N, Al-Badawi MG, Fatanti JA, Meshari AA, Edrees YB, Jabbar FA (1989) Fetal necrogram: a new technique. Experience with 12,000 contrast examinations. Invest Radiol 24:711–720PubMedCrossRefGoogle Scholar
  28. Isaacson G (1984) Postmortem examination of infant brains. Arch Pathol Lab Med 108:80–81PubMedGoogle Scholar
  29. Kalifa G, Barbet JP, Labbe F, Houette A, Sellier N (1989) Value of systemic post mortem radiographic examinations of fetuses — 400 cases. Pediatr Radiol 19:111–113PubMedCrossRefGoogle Scholar
  30. Keeling JW, Gibson AAM, Cole SK (1994) Perinatal necropsies in Scotland. J Pathol 172 Suppl: 150ACrossRefGoogle Scholar
  31. Kelehan P (1984) Technique for removal of the newborn middle and inner ear. In: Wigglesworth JS (ed) Perinatal pathology. Saunders, Philadelphia, pp 431–433Google Scholar
  32. Khong TY (1996) A review of perinatal autopsy rates worldwide, 1960’s to 1990’s. Paed Peri Epidem 10:97–105CrossRefGoogle Scholar
  33. Khong TY, Mansor FA, Staples AJ (1995) Are perinatal autopsy rates satisfactory? Med J Aust 162:469–70PubMedGoogle Scholar
  34. Kjaer I, Keeling JW, Graem N (1991) The midline craniofacial skeleton in holoprosencephalic fetuses. J Med Genet 28:846–855PubMedCrossRefGoogle Scholar
  35. Kliegman RM, King KC (1983) Intrauterine growth retardation: determinants of aberrant fetal growth. In: Fanaroff AA, Martin RJ (eds) Behrman’s neonatal-perinatal medicine: diseases of the fetus and infant, 3rd edn. Mosby, St Louis, pp 49–80Google Scholar
  36. Langer B, Choquet P, Ravier S, Gasser B, Schlaeder G, Constantinesco A (1998) Low-field dedicated magnetic resonance imaging: a potential tool for assisting perinatal autopsy. Ultrasound Obstet Gynecol 12:271–275PubMedCrossRefGoogle Scholar
  37. Langley FA (1971) The perinatal postmortem examination. J clin Pathol 24:159–169PubMedCrossRefGoogle Scholar
  38. Laurence KM, Martin D (1959) A technique for obtaining undistorted specimens of the central nervous system. J Clin Pathol 12:188–190PubMedCrossRefGoogle Scholar
  39. Lucas A, Cole TJ, Gandy GM (1986) Birthweight centiles in preterm infants reappraised. Early Hum Dev 13:313–322PubMedCrossRefGoogle Scholar
  40. Milner RDG, Richards B (1974) An analysis of birth weight by gestational age of infants born in England and Wales, 1967 to 1971. J Obstet Gynaecol Br Common 81: 956–967CrossRefGoogle Scholar
  41. Mueller RF, Sybert VP, Johnson J, Brown ZA, Chen WJ (1983) Evaluation of a protocol for postmortem examination of stillbirths. N Engl J Med 309:586–590PubMedCrossRefGoogle Scholar
  42. Muller J, McCombs RV (1984) Brain-cutting device for correlation with CT-scan planes of section. Acta Neuropathol (Berl) 62:257–258CrossRefGoogle Scholar
  43. Naeye RL (1983) The investigation of perinatal deaths. N Engl J Med 309:611–612PubMedCrossRefGoogle Scholar
  44. Naeye RD (1985) Umbilical cord length: clinical significance. J Pediatr 107:278–281PubMedCrossRefGoogle Scholar
  45. Porter HJ, Keeling JW, (1987) The value of the perinatal postmortem examination. J. Clin Pathol 40:180–184PubMedCrossRefGoogle Scholar
  46. Pryse-Davies J (1981) The perinatal autopsy. In: Anthony PP, MacSween RNM (eds) Recent advances in histopathology. Churchill Livingstone, Edinburgh, pp 65–82Google Scholar
  47. Pryse-Davies J, Hurley R (1979) Infections and perinatal mortality. J Antimicrob Chemother 5 (Suppl A):59–70PubMedCrossRefGoogle Scholar
  48. Pryse-Davies J, Smitham JH, Napier KA (1974) Factors influencing development of secondary ossification centres in the fetus and newborn. Arch Dis Child 49:425–431PubMedCrossRefGoogle Scholar
  49. Royal College of Pathologists (1993) Guidelines for postmortem reports. Roy Coll Pathol LondGoogle Scholar
  50. Rushton DI (1981) Examination of products of conception from previable human pregnancies. J Clin Pathol 34:819–835PubMedCrossRefGoogle Scholar
  51. Rushton DI (1982) Resource implications of examination of the placenta. In: Organisation of perinatal pathology services. Harrogate seminar reports 6. Crown Copyright 1981.Google Scholar
  52. Rushton DI (1991) West Midlands perinatal mortality survey, 1987. An audit of 300 perinatal autopsies. Br J Obs Gynaecol 98:624–627CrossRefGoogle Scholar
  53. Rushton DI (1994) Prognostic role of the perinatal postmortem. Br J Hosp Med 52(9):450–454PubMedGoogle Scholar
  54. Russell GA (1994) Specimen photography. ACP News: 19–22Google Scholar
  55. Russell JGB (1981) Radiological assessment of age, retardation and death. In: Barson AJ (ed) Laboratory investigation of fetal disease. Wright, Bristol, pp 3–16Google Scholar
  56. Sailer DN Jr, Lesser KB, Harrel U, Rogers BB, Oyer CE (1995) J Amer Med Ass 273(8):663–665CrossRefGoogle Scholar
  57. Streeter GL (1921) Weight, sitting height, head size, foot length, and menstrual age of the human embryo. Contrib Embryol Carnegie Inst 55:143–170Google Scholar
  58. Stempflé N, Huten Y, Fondacci C, Lang T, Hassan M, Nessmann C (1995) Fetal bone age revisited: proposal of a new radiographic score. Pediatr Radiol 25:551–555PubMedCrossRefGoogle Scholar
  59. Sutherland GR, Carter RF (1983) Cytogenetic studies: an essential part of the paediatric necropsy. J Clin Pathol 36:140–142PubMedCrossRefGoogle Scholar
  60. Sutton L, Bajuk B (1996) Postmortem examinations in a statewide audit of neonatal intensive care unit admissions in Australia in 1992. New South Wales Neonatal Intensive Care Unit Study Group. Acta Paed 85:865–9CrossRefGoogle Scholar
  61. Tasdelen E, Aksoy F, Arvas A, Berk Y, Ataoglu N, Dervisoglu S et al. (1995) Causes of fetal and neonatal death. Turk J Pediat 37:201–7Google Scholar
  62. Thornton CM, O’Hara MD (1998) A regional audit of perinatal and infant autopsies in Northern Ireland. Br J Obstet Gynaecol 105:18–23PubMedCrossRefGoogle Scholar
  63. Valdes-Dapena M, Huff DS (1983) Perinatal autopsy manual. Armed Forces Institute of Pathology, Washington DCGoogle Scholar
  64. Vujanic GM, Cartlidge PHT, Stewart JH, Dawson AJ (1995) Perinatal and infant postmortem examinations: how well are we doing? J Clin Pathol 48:998–1001PubMedCrossRefGoogle Scholar
  65. Vujanic GM, Cartlidge PHT, Stewart JH (1998) Improving the quality of perinatal and infant postmortem examinations: a follow up study. J Clin Pathol 51:850–853PubMedCrossRefGoogle Scholar
  66. Wigglesworth JS (ed) (1984) Performance of the perinatal autopsy. In: Wigglesworth JS (ed) Perinatal pathology. Saunders, Philadelphia, 99:48–83Google Scholar
  67. Wigglesworth JS, Husemeyer RP (1977) Intracranial birth trauma in vaginal breech delivery: the continued importance of injury to the occipital bone. Br J Obstet Gynaecol 84:684–691PubMedGoogle Scholar
  68. Woodward PJ, Sohaey R, Harris DP, Jackson GM, Klatt EC, Alexander AL et al. (1997) Postmortem fetal MR imaging: comparison with findings at autopsy. Am J Roentgen 168:41–6Google Scholar
  69. Working Party of Obstetricians and Paediatricians in Europe (1970) Report of working party to discuss nomenclature based on gestational age and birth weight. Arch Dis child 45:730CrossRefGoogle Scholar
  70. Yagel S, Adoni A, Oman S, Wax Y, Hochner-Celnikier D (1986) A statistical examination of the accuracy of combining femoral length and biparietal diameter as an index of fetal gestational age. Br J Obstet Gynaecol 93:109–115PubMedCrossRefGoogle Scholar
  71. Yates PO (1959) Birth trauma to the vertebral arteries, Arch Dis Child 34:436–441PubMedCrossRefGoogle Scholar
  72. Yudkin PL, Aboualfa M, Eyre JA, Redman CWG, Wilkinson AR (1987) The influence of elective preterm delivery on birth-weight and head circumference standards. Arch Dis Child 62:24–29PubMedCrossRefGoogle Scholar
  73. Zaaijman J du T, Wilkinson AR, Keeling JW, Mitchell RG, Turnbull AC (1982) Spontaneous premature rupture of the membranes: bacteriology, histology and neonatal outcome. J Obstet Gynaecol 2:155–160CrossRefGoogle Scholar

Copyright information

© Springer-Verlag London 2001

Authors and Affiliations

  • Jean W. Keeling

There are no affiliations available

Personalised recommendations