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.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
References
Alberman E (1980) Prospects for better perinatal health. Lancet 1:189–192.
Alberman ED, Creasy MR (1977) Frequency of chromosomal abnormalities in miscarriages and perinatal deaths. J Med Genet 14:313–315.
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.
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.
Barson AJ (1981) The perinatal postmortem. In: Barson AJ (ed) Laboratory Investigation of Fetal Disease. Wright, Bristol, pp. 476–497.
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.
Becher J-C, Laing IA, Keeling JW, McIntosh N (2004) Restoring high neonatal autopsy rates Lancet 364:2019–2020.
Billson V, Masterton RG, Keeling JW (1993) How useful is postmortem bacteriological investigation? J Pathol 169(suppl):120A.
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.
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.
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.
Boyd PA, Brown RA, Stewart WJ (1980) Quantitative structural differences within the normal term human placenta: a pilot study. Placenta 1:337–344.
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.
Brookes JAS, Hall-Craggs MA, Sams VR, Lees WR (1996) Non-invasive perinatal necropsy by magnetic resonance imaging. Lancet 1:1139–1141.
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.
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.
Chamberlain GVP (1985) the length of labour. In: Crawford JW (ed) Risks of Labour. Wiley, Chichester, pp. 1–10.
Chambers HM (1992) The perinatal autopsy: a contemporary approach. Pathology 24:45–55.
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.
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.
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.
Dorovini-Zis K, Dolman CL (1977) Gestational development of brain. Arch Pathol Lab Med 101:192– 195.
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.
Foote GA, Wilson AJ, Stewart JH (1978) Perinatal postmortem radiography-experience with 2500 cases. Br J Radiol 51:351–356.
Furness ME, Weckert RC, Parker SA, Knowles S (1989) Ultrasound in the perinatal necropsy. J Med Genet 26:368–372.
Gairdner D, Pearson J (1971) A growth chart for premature and other infants. Arch Dis Child 46:783– 794.
Gatzoulis MA, Sheppard MN, Ho SY (1996) Value and impact of necropsy in paediatric cardiology. Heart 75:626–631.
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.
Huisman TAGM (2004) Magnetic resonance imaging: an alternative to autopsy in neonatal death? Semin Neonat 9:347–353.
Isaacson G (1984) Postmortem examination of infant brains. Arch Pathol Lab Med 108:80–81.
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.
Keeling JW, Gibson AAM, Cole SK (1994) Perinatal necropsies in Scotland. J Pathol 172(suppl): 150A.
Kelehan P (1984) Technique for removal of the newborn middle and inner ear. In: Wigglesworth JS (ed) Perinatal Pathology. Saunders, Philadelphia, pp. 431–433.
Khong TY (1996) A review of perinatal autopsy rates worldwide, 1960's to 1990's. Paediatr Peri Epidemiol 10:97–105.
Khong TY, Mansor FA, Staples AJ (1995) Are perinatal autopsy rates satisfactory? Med J Aust 162:469–470.
Kjaer I, Keeling JW, Graem N (1991) The midline cra-niofacial skeleton in holoprosencephalic fetuses. J Med Genet 28:846–855.
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.
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.
Langley FA (1971) The perinatal postmortem examination. J Clin Pathol 24:159–169.
Laurence KM, Martin D (1959) A technique for obtaining undistorted specimens of the central nervous system. J Clin Pathol 12:188–190.
Lucas A, Cole TJ, Gandy GM (1986) Birthweight centiles in preterm infants reappraised. Early Hum Dev 13:313–322.
Machin GA, Ackerman J, Gilbert-Barness E. (2000) Abnormal umbilical cord coiling is associated with adverse perinatal outcome. Pediatr Devel Pathol 3:462–471.
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.
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.
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.
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.
Muller J, McCombs RV (1984) Brain-cutting device for correlation with CT-scan planes of section. Acta Neu-ropathol (Berl) 62:257–258.
Naeye RL (1983) the investigation of perinatal deaths. N Engl J Med 309:611–612.
Naeye RD (1985) Umbilical cord length: clinical signifi -cance. J Pediatr 107:278–281.
Pinar H, Sung CJ, Oyer CE, Singer DB (1996) Reference values for singleton and twin placental weight. Pediatr Pathol Lab Med 16:901–907.
Porter HJ, Keeling JW (1987) The value of the perinatal postmortem examination. J Clin Pathol 40:180–184.
Pryse-Davies J (1981) The perinatal autopsy. In: Anthony PP, MacSween RNM (eds) Recent Advances in Histopathology. Churchill Livingstone, Edinburgh, pp. 65–82.
Pryse-Davies J, Hurley R (1979) Infections and perinatal mortality. J Antimicrob Chemother 5(suppl A):59–70.
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.
Royal College of Pathologists (1993) Guidelines for postmortem reports. R Coll Pathol Lond pp. 1–16.
Rushton DI (1982) Resource implications of examination of the placenta. In: Organisation of Perinatal Pathology Services. Harrogate Seminar Reports 6. Crown Copyright. London.
Rushton DI (1991) West Midlands perinatal mortality survey, 1987. An audit of 300 perinatal autopsies. Br J Obstet Gynaecol 98:624–627.
Rushton DI (1994) Prognostic role of the perinatal postmortem. Br J Hosp Med 52:450–454.
Russell GA (1994) Specimen photography. ACP News 19–22.
Russell JGB (1981) Radiological assessment of age, retardation and death. In: Barson AJ (ed) Laboratory Investigation of Fetal Disease. Wright, Bristol, pp. 3–16.
Saller DN Jr, Lesser KB, Harrel U, Rogers BB, Oyer CE (1995) The clinical utility of the perinatal autopsy. JAMA 273:663–665.
Sington J, Cottrell B (2001) Medical error reporting must take necropsy data into account. Br Med J 323:511.
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.
Sutherland GR, Carter RF (1983) Cytogenetic studies: an essential part of the paediatric necropsy. J Clin Pathol 36:140–142.
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.
Tasdelen E, Aksoy F, Arvas A, et al. (1995) Causes of fetal and neonatal death. Turk J Pediatr 37: 201–207.
Thornton CM, O'Hara MD (1998) A regional audit of perinatal and infant autopsies in Northern Ireland. Br J Obstet Gynaecol 105:18–23.
Valdes-Dapena M, Huff DS (1983) Perinatal Autopsy Manual. Armed Forces Institute of Pathology, Washington, DC.
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.
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.
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.
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.
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.
Wigglesworth JS (1984) Performance of the perinatal autopsy. In: Wigglesworth JS (ed) Perinatal Pathology. WB Saunders, Philadelphia, 99:48–83.
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.
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.
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.
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.
Yates PO (1959) birth trauma to the vertebral arteries. Arch Dis Child 34:436–441.
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.
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.
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2007 Springer-Verlag London Limited
About this chapter
Cite this chapter
Keeling, J.W. (2007). The Perinatal Necropsy. In: Keeling, J.W., Khong, T.Y. (eds) Fetal and Neonatal Pathology. Springer, London. https://doi.org/10.1007/978-1-84628-743-5_2
Download citation
DOI: https://doi.org/10.1007/978-1-84628-743-5_2
Publisher Name: Springer, London
Print ISBN: 978-1-84628-524-0
Online ISBN: 978-1-84628-743-5
eBook Packages: MedicineMedicine (R0)