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-oriented service for adult patients. Examination of stillborn infants has been particularly neglected. This is probably related to negative expectations concerning the likelihood of making specific diagnoses.

Necropsy information is of practical importance at three different levels of clinical practice. First, it is important to the family of the dead baby and to the clinicians involved in their care. Second, necropsy findings are necessary for adequate audit of unit policies and practices. Third, data derived from postmortem examination make an important contribution to regional or national statistics by complementing clinical data collection. Some necropsy data are appropriate to all three levels of enquiry, but each requires answers to specific questions.


Neonatal Death Postmortem Examination Perinatal Death Anterior Fontanelle Necropsy Examination 
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  1. Alberman E (1980) Prospects for better perinatal health. Lancet 1:189–192.PubMedCrossRefGoogle Scholar
  2. Alberman ED, Creasy MR (1977) Frequency of chromosomal abnormalities in miscarriages and perinatal deaths. J Med Genet 14:313–315.PubMedCrossRefGoogle Scholar
  3. Alderliesten ME, Peringa J, van der Hulst VPM, et al. (2003) Perinatal mortality: clinical value of magnetic resonance imaging compared with autopsy in routine obstetric practice. Br J Obstet Gynaecol 110:378–382.Google Scholar
  4. Alonso K, Portman E (1995) Fetal weights and measurements as determined by postmortem examination and their correlation with ultrasound examination. Arch Pathol Lab Med 119:179–180.PubMedGoogle Scholar
  5. Barson AJ (1981) The perinatal postmortem. In: Barson AJ (ed) Laboratory Investigation of Fetal Disease. Wright, Bristol, pp. 476–497.Google Scholar
  6. 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. 13–14.Google Scholar
  7. Becher J-C, Laing IA, Keeling JW, McIntosh N (2004) Restoring high neonatal autopsy rates Lancet 364:2019–2020.PubMedCrossRefGoogle Scholar
  8. Billson V, Masterton RG, Keeling JW (1993) How useful is postmortem bacteriological investigation? J Pathol 169(suppl):120A.Google 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. 67–132.Google Scholar
  10. Bourliere-Najean B, Russel AS, Panuel M, et al. (2003) Value of fetal skeletal radiographs in the diagnosis of fetal death. Eur Radiol 13:1046–1049.PubMedGoogle Scholar
  11. 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 121:368–376.Google Scholar
  12. Boyd PA, Brown RA, Stewart WJ (1980) Quantitative structural differences within the normal term human placenta: a pilot study. Placenta 1:337–344.PubMedCrossRefGoogle Scholar
  13. Brodlie M, Laing IA, Keeling JW, McKenzie KJ (2002) Ten years of neonatal autopsies in a tertiary referral unit: retrospective study. Br Med J 321: 761–763.CrossRefGoogle Scholar
  14. Brookes JAS, Hall-Craggs MA, Sams VR, Lees WR (1996) Non-invasive perinatal necropsy by magnetic resonance imaging. Lancet 1:1139–1141.CrossRefGoogle Scholar
  15. Campbell S, Pearce JMF (1985) Ultrasound in obstetrics and gynaecology. In: Mcdonald RR (ed) Scientifi c Basis of Obstetrics and Gynaecology. Churchill Livingstone, Edinburgh, pp. 304–349.Google Scholar
  16. 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 310:155–158.Google Scholar
  17. Chamberlain GVP (1985) the length of labour. In: Crawford JW (ed) Risks of Labour. Wiley, Chichester, pp. 1–10.Google Scholar
  18. Chambers HM (1992) The perinatal autopsy: a contemporary approach. Pathology 24:45–55.PubMedCrossRefGoogle Scholar
  19. Confi dential Enquiry into Maternal and Child Health (2005) Stillbirth, neonatal and post neonatal mortality 2000–2002, England, Wales and Northern Ireland. RCOG Press, London.Google Scholar
  20. 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 1:145–149.PubMedCrossRefGoogle Scholar
  21. De Laat MW, van Alderen ED, Franx A, Visser GH, Bots ML, Nikkels PG. (2006) The umbilical coiling index in complicated pregnancy. Eur J Obstet Gynecol Reprod Biol 130:66–72.PubMedGoogle Scholar
  22. Dorovini-Zis K, Dolman CL (1977) Gestational development of brain. Arch Pathol Lab Med 101:192– 195.PubMedGoogle Scholar
  23. Emery JL, Kalpaktsoglou PK (1967) The costochon-dral junction during later stages of intrauterine life, and abnormal growth patterns found in association with perinatal death. Arch Dis Child 42:1–13.PubMedCrossRefGoogle Scholar
  24. Foote GA, Wilson AJ, Stewart JH (1978) Perinatal postmortem radiography-experience with 2500 cases. Br J Radiol 51:351–356.PubMedCrossRefGoogle Scholar
  25. Furness ME, Weckert RC, Parker SA, Knowles S (1989) Ultrasound in the perinatal necropsy. J Med Genet 26:368–372.PubMedCrossRefGoogle Scholar
  26. Gairdner D, Pearson J (1971) A growth chart for premature and other infants. Arch Dis Child 46:783– 794.PubMedCrossRefGoogle Scholar
  27. Gatzoulis MA, Sheppard MN, Ho SY (1996) Value and impact of necropsy in paediatric cardiology. Heart 75:626–631.PubMedCrossRefGoogle Scholar
  28. 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 24:711–720.Google Scholar
  29. Huisman TAGM (2004) Magnetic resonance imaging: an alternative to autopsy in neonatal death? Semin Neonat 9:347–353.CrossRefGoogle Scholar
  30. Isaacson G (1984) Postmortem examination of infant brains. Arch Pathol Lab Med 108:80–81.PubMedGoogle Scholar
  31. Kalifa G, Barbet JP, Labbe F, Houette A, Sellier N (1989) Value of systemic post mortem radiographic examinations of fetuses—400 cases. Pediatr Radiol 19:111–113.PubMedCrossRefGoogle Scholar
  32. Keeling JW, Gibson AAM, Cole SK (1994) Perinatal necropsies in Scotland. J Pathol 172(suppl): 150A.Google Scholar
  33. Kelehan P (1984) Technique for removal of the newborn middle and inner ear. In: Wigglesworth JS (ed) Perinatal Pathology. Saunders, Philadelphia, pp. 431–433.Google Scholar
  34. Khong TY (1996) A review of perinatal autopsy rates worldwide, 1960's to 1990's. Paediatr Peri Epidemiol 10:97–105.CrossRefGoogle Scholar
  35. Khong TY, Mansor FA, Staples AJ (1995) Are perinatal autopsy rates satisfactory? Med J Aust 162:469–470.PubMedGoogle Scholar
  36. Kjaer I, Keeling JW, Graem N (1991) The midline cra-niofacial skeleton in holoprosencephalic fetuses. J Med Genet 28:846–855.PubMedCrossRefGoogle Scholar
  37. 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 ed. Mosby, St Louis, pp. 49–80.Google Scholar
  38. Langer B, Choquet P, Ravier S, Gasser B, Schlaeder G, Constantinesco A (1998) Low-fi eld dedicated magnetic resonance imaging: a potential tool for assisting perinatal autopsy. Ultrasound Obstet Gynecol 12:271–275.PubMedCrossRefGoogle Scholar
  39. Langley FA (1971) The perinatal postmortem examination. J Clin Pathol 24:159–169.PubMedCrossRefGoogle Scholar
  40. Laurence KM, Martin D (1959) A technique for obtaining undistorted specimens of the central nervous system. J Clin Pathol 12:188–190.PubMedCrossRefGoogle Scholar
  41. Lucas A, Cole TJ, Gandy GM (1986) Birthweight centiles in preterm infants reappraised. Early Hum Dev 13:313–322.PubMedCrossRefGoogle Scholar
  42. Machin GA, Ackerman J, Gilbert-Barness E. (2000) Abnormal umbilical cord coiling is associated with adverse perinatal outcome. Pediatr Devel Pathol 3:462–471.CrossRefGoogle Scholar
  43. Maroun LL, Graem N (2005) Autopsy standards of body parameters and fresh organ weights in non-macerated and macerated human fetuses. Pediatr Dev Pathol 8:204–217.PubMedCrossRefGoogle Scholar
  44. Meyer-Wittkopf M, Cook A, McLennan A, et al. (1996) Evaluation of three-dimensional ultrasonography and magnetic resonance imaging in assessment of congenital cardiac anomalies in fetal cardiac specimens. Ultrasound Obstet Gynecol 8:303–308.PubMedCrossRefGoogle Scholar
  45. 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 81:956–967.Google Scholar
  46. 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– 590.PubMedGoogle Scholar
  47. Muller J, McCombs RV (1984) Brain-cutting device for correlation with CT-scan planes of section. Acta Neu-ropathol (Berl) 62:257–258.CrossRefGoogle Scholar
  48. Naeye RL (1983) the investigation of perinatal deaths. N Engl J Med 309:611–612.PubMedCrossRefGoogle Scholar
  49. Naeye RD (1985) Umbilical cord length: clinical signifi -cance. J Pediatr 107:278–281.PubMedCrossRefGoogle Scholar
  50. Pinar H, Sung CJ, Oyer CE, Singer DB (1996) Reference values for singleton and twin placental weight. Pediatr Pathol Lab Med 16:901–907.PubMedGoogle Scholar
  51. Porter HJ, Keeling JW (1987) The value of the perinatal postmortem examination. J Clin Pathol 40:180–184.PubMedCrossRefGoogle Scholar
  52. Pryse-Davies J (1981) The perinatal autopsy. In: Anthony PP, MacSween RNM (eds) Recent Advances in Histopathology. Churchill Livingstone, Edinburgh, pp. 65–82.Google Scholar
  53. Pryse-Davies J, Hurley R (1979) Infections and perinatal mortality. J Antimicrob Chemother 5(suppl A):59–70.PubMedGoogle Scholar
  54. Pryse-Davies J, Smitham JH, Napier KA (1974) Factors infl uencing development of secondary ossifi cation centres in the fetus and newborn. Arch Dis Child 49:425–431.PubMedCrossRefGoogle Scholar
  55. Royal College of Pathologists (1993) Guidelines for postmortem reports. R Coll Pathol Lond pp. 1–16.Google Scholar
  56. Rushton DI (1982) Resource implications of examination of the placenta. In: Organisation of Perinatal Pathology Services. Harrogate Seminar Reports 6. Crown Copyright. London.Google Scholar
  57. Rushton DI (1991) West Midlands perinatal mortality survey, 1987. An audit of 300 perinatal autopsies. Br J Obstet Gynaecol 98:624–627.PubMedGoogle Scholar
  58. Rushton DI (1994) Prognostic role of the perinatal postmortem. Br J Hosp Med 52:450–454.PubMedGoogle Scholar
  59. Russell GA (1994) Specimen photography. ACP News 19–22.Google Scholar
  60. Russell JGB (1981) Radiological assessment of age, retardation and death. In: Barson AJ (ed) Laboratory Investigation of Fetal Disease. Wright, Bristol, pp. 3–16.Google Scholar
  61. Saller DN Jr, Lesser KB, Harrel U, Rogers BB, Oyer CE (1995) The clinical utility of the perinatal autopsy. JAMA 273:663–665.PubMedCrossRefGoogle Scholar
  62. Sington J, Cottrell B (2001) Medical error reporting must take necropsy data into account. Br Med J 323:511.CrossRefGoogle Scholar
  63. 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 25:551–555.PubMedCrossRefGoogle Scholar
  64. Sutherland GR, Carter RF (1983) Cytogenetic studies: an essential part of the paediatric necropsy. J Clin Pathol 36:140–142.PubMedCrossRefGoogle Scholar
  65. 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 Pae-diatr 85:865–869.Google Scholar
  66. Tasdelen E, Aksoy F, Arvas A, et al. (1995) Causes of fetal and neonatal death. Turk J Pediatr 37: 201–207.PubMedGoogle Scholar
  67. Thornton CM, O'Hara MD (1998) A regional audit of perinatal and infant autopsies in Northern Ireland. Br J Obstet Gynaecol 105:18–23.PubMedGoogle Scholar
  68. Valdes-Dapena M, Huff DS (1983) Perinatal Autopsy Manual. Armed Forces Institute of Pathology, Washington, DC.Google Scholar
  69. Van der Harten JJ, Brons JT, Schipper NW, et al. (1990) The prenatal development of the normal human skeleton: a combined ultrasonographic and postmortem radiographic study. Pediatr Radiol 21:52–56.PubMedCrossRefGoogle Scholar
  70. Van Dijk CC, Franx A, de Laat MW, Bruinse HW, Visser GH, Nikkels PG (2002) The umbilical coiling index in normal pregnancy. J Matern Fetal Neonatal Med 11:280–283.CrossRefGoogle Scholar
  71. Vujanic GM, Cartlidge PHT, Stewart JH (1998) Improving the quality of perinatal and infant postmortem examinations: a follow up study. J Clin Pathol 51:850–853.PubMedCrossRefGoogle Scholar
  72. Vujanic GM, Cartlidge PHT, Stewart JH, Dawson AJ (1995) Perinatal and infant postmortem examinations: how well are we doing? J Clin Pathol 48:998–1001.PubMedCrossRefGoogle Scholar
  73. Whitby EH, Paley MN, Cohen M, Griffi ths PD (2006) Postmortem fetal MRI: what do we learn from it? Eur J Radiol 57:250–255.PubMedCrossRefGoogle Scholar
  74. Wigglesworth JS (1984) Performance of the perinatal autopsy. In: Wigglesworth JS (ed) Perinatal Pathology. WB Saunders, Philadelphia, 99:48–83.Google Scholar
  75. 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 84:684–691.PubMedGoogle Scholar
  76. Woodward PJ, Sohaey R, Harris DP, et al. (1997) Postmortem fetal MR imaging: comparison with fi ndings at autopsy. Am J Roentgen 168:41–46.Google Scholar
  77. 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 45:730.CrossRefGoogle Scholar
  78. 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 93:109–115.PubMedGoogle Scholar
  79. Yates PO (1959) birth trauma to the vertebral arteries. Arch Dis Child 34:436–441.PubMedCrossRefGoogle Scholar
  80. Yudkin PL, Aboualfa M, Eyre JA, Redman CWG, Wilkinson AR (1987) The infl uence of elective preterm delivery on birthweight and head circumference standards. Arch Dis Child 62:24–29.PubMedCrossRefGoogle Scholar
  81. 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– 160.CrossRefGoogle Scholar

Copyright information

© Springer-Verlag London Limited 2007

Authors and Affiliations

  • Jean W. Keeling
    • 1
  1. 1.Infirmary of Edinburgh, University of EdinburghRoyal Hospital for Sick Children and RoyalEdinburghUK

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