Pediatric Radiology

, Volume 44, Issue 3, pp 252–257 | Cite as

Routine perinatal and paediatric post-mortem radiography: detection rates and implications for practice

  • Owen J. Arthurs
  • Alistair D. Calder
  • Liina Kiho
  • Andrew M. Taylor
  • Neil J. Sebire
Original Article



Routine perinatal and paediatric post-mortem plain radiography allows for the diagnosis and assessment of skeletal dysplasias, fractures and other bony abnormalities.


The aim of this study was to review the diagnostic yield of this practice.

Materials and methods

We identified 1,027 cases performed in a single institution over a 2½-year period, including babygrams (whole-body examinations) and full skeletal surveys. Images were reported prior to autopsy in all cases. Radiology findings were cross-referenced with the autopsy findings using an autopsy database. We scored each case from 0 to 4 according to the level of diagnostic usefulness.


The overall abnormality rate was 126/1,027 (12.3%). There was a significantly higher rate of abnormality when a skeletal survey was performed (18%) rather than a babygram (10%; P < 0.01); 90% (665/739) of babygrams were normal. Of the 74 abnormal babygrams, we found 33 incidental non-contributory cases, 19 contributory, 20 diagnostic, and 2 false-positive cases. There were only 2 cases out of 739 (0.27%) in whom routine post-mortem imaging identified potentially significant abnormalities that would not have been detected if only selected imaging had been performed. A policy of performing selected, rather than routine, foetal post-mortem radiography could result in a significant cost saving.


Routine post-mortem paediatric radiography in foetuses and neonates is neither diagnostically useful nor cost-effective. A more evidence-based, selective protocol should yield significant cost savings.


Radiography Post-mortem Foetal Perinatal Dysplasia 


Conflicts of interest

Dr Owen Arthurs is funded by a National Institute for Health Research (NIHR) Clinician Scientist Fellowship, and Professor Andrew M. Taylor is funded by an NIHR Senior Research Fellowship. Professor Neil J. Sebire, Professor Lyn Chitty and Professor Andrew M Taylor are partially supported by the Great Ormond Street Children’s Charity and the Great Ormond Street Hospital Biomedical Research Centre. This article presents independent research funded by the NIHR and supported by the Great Ormond Street Hospital Biomedical Research Centre. The views expressed are those of the authors and are not necessarily those of the National Health Service, the NIHR or the Department of Health.


  1. 1.
    Pauli RM (2010) Stillbirth: fetal disorders. Clin Obstet Gynecol 53:646–655PubMedCrossRefGoogle Scholar
  2. 2.
    Wright C, Lee RE (2004) Investigating perinatal death: a review of the options when autopsy consent is refused. Arch Dis Child Fetal Neonatal Ed 89:F285–F288PubMedCentralPubMedCrossRefGoogle Scholar
  3. 3.
    Royal College of Pathologists Working Party on the Autopsy (2006) Guidelines on autopsy practice: scenario 9: stillborn infant (singleton). (Accessed 18 Feb 2012)
  4. 4.
    Hughes Roberts Y, Arthurs OJ, Moss HM et al (2012) Post mortem skeletal surveys in suspected non-accidental injury. Clin Radiol 67:868–876PubMedCrossRefGoogle Scholar
  5. 5.
    Olsen O, Espeland A, Maartman-Moe H et al (2003) Diagnostic value of radiography in cases of perinatal death: a population based study. Arch Dis Child Fetal Neonatal Ed 88:F521–F524PubMedCentralCrossRefGoogle Scholar
  6. 6.
    Vogt C, Blaas HG, Salvesen KÅ et al (2012) Comparison between prenatal ultrasound and postmortem findings in fetuses and infants with developmental anomalies. Ultrasound Obstet Gynecol 39:666–672PubMedCrossRefGoogle Scholar
  7. 7.
    Roberts IS, Benamore RE, Benbow EW et al (2012) Post-mortem imaging as an alternative to autopsy in the diagnosis of adult deaths: a validation study. Lancet 379:136–142PubMedCentralPubMedCrossRefGoogle Scholar
  8. 8.
    O’Donoghue K, O’Regan KN, Sheridan CP et al (2012) Investigation of the role of computed tomography as an adjunct to autopsy in the evaluation of stillbirth. Eur J Radiol 81:1667–1675PubMedCrossRefGoogle Scholar
  9. 9.
    Thayyil S, Sebire NJ, Chitty LS et al (2011) Post mortem magnetic resonance imaging in the fetus, infant and child: a comparative study with conventional autopsy (MaRIAS Protocol). BMC Pediatr 11:120PubMedCentralPubMedCrossRefGoogle Scholar
  10. 10.
    Seppanen U (1985) The value of perinatal post-mortem radiography: experience of 514 cases. Ann Clin Res 44:1–59Google Scholar
  11. 11.
    Cremin BJ, Draper R (1981) The value of radiography in perinatal deaths. Pediatr Radiol 11:143–146PubMedCrossRefGoogle Scholar
  12. 12.
    Foote GA, Wilson AJ, Stewart JH (1978) Perinatal post-mortem radiography – experience with 2,500 cases. Br J Radiol 51:351–356PubMedCrossRefGoogle Scholar
  13. 13.
    Kalifa G, Barbet JP, Labbe F et al (1989) Value of systematic post mortem radiographic examinations of fetuses – 400 cases. Pediatr Radiol 19:111–113PubMedCrossRefGoogle Scholar
  14. 14.
    Bourlière-Najean B, Russel AS, Panuel M et al (2003) Value of fetal skeletal radiographs in the diagnosis of fetal death. Eur Radiol 13:1046–1049PubMedGoogle Scholar
  15. 15.
    Sieswerda-Hoogendoorn T, van Rijn RR (2010) Current techniques in postmortem imaging with specific attention to paediatric applications. Pediatr Radiol 40:141–152PubMedCentralPubMedCrossRefGoogle Scholar
  16. 16.
    Désilets V, Oligny LL, Genetics Committee of the Society of Obstetricians and Gynaecology Canada et al (2011) Fetal and perinatal autopsy in prenatally diagnosed fetal abnormalities with normal karyotype. J Obstet Gynaecol Can 33:1047–1057PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Owen J. Arthurs
    • 1
    • 5
  • Alistair D. Calder
    • 1
  • Liina Kiho
    • 2
  • Andrew M. Taylor
    • 3
    • 4
    • 5
  • Neil J. Sebire
    • 2
    • 5
  1. 1.Department of Radiology Great Ormond Street Hospital for ChildrenNHS Foundation TrustLondonUK
  2. 2.Department of Paediatric PathologyCamelia Botnar Laboratories Great Ormond Street Hospital for ChildrenLondonUK
  3. 3.Cardiorespiratory UnitGreat Ormond Street Hospital for ChildrenLondonUK
  4. 4.UCL Institute of Cardiovascular ScienceLondonUK
  5. 5.Institute of Child HealthUniversity College LondonLondonUK

Personalised recommendations