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Fetale Obduktionen

Veraltetes Relikt oder nach wie vor ein Goldstandard?

Fetal autopsies

Relic or still a gold standard?

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Zusammenfassung

Hintergrund

Die Durchführung fetaler Obduktionen ist rückläufig, obwohl sie für betroffene Eltern neben einer Ursachenklärung bei Abort richtungsweisende Informationen hinsichtlich Wiederholungsrisiken bei Folgeschwangerschaften generieren kann.

Ziel der Arbeit

Ziel der Arbeit ist es, die Entwicklung fetaler Obduktionen der letzten 10 Jahre zu analysieren und zu überprüfen, welche Informationen durch eine fetale Obduktion gewonnen werden können.

Material und Methoden

Retrospektiv wurden fetale Obduktionsbefunde zweier Universitätsinstitute für Pathologie aus den Jahren 2005 bis 2014 ausgewertet. Berücksichtigt wurden neben demographischen Daten die Korrelation von pränataler Diagnose mit dem Obduktionsbefund, Unterschiede zwischen spontanen und induzierten Todesfällen sowie Charakteristika beider Institute.

Ergebnisse

Insgesamt wurden 428 fetale Obduktionen durchgeführt, wobei die Anzahl im Studienzeitraum um 24,2 % sank. Bei 29,7 % aller Obduktionen handelte es sich um induzierte Aborte, deren Fehlbildungen sich erwartungsgemäß deutlich von denen der spontanen Aborte und intrauterinen Fruchttode unterschieden (p < 0,001). Bei 116 der 428 Obduktionen (27,1 %) konnte keine Fehlbildung bzw. Todesursache detektiert werden, wobei es sich bei 95,7 % dieser Fälle um spontane Aborte handelte. Bei insgesamt 29 Obduktionen (6,8 %) bestand eine Diskrepanz zwischen klinischem Befund und Obduktionsergebnis. In 15 Fällen (3,5 %) lieferte die Obduktion mindestens eine ergänzende Anomalie im Vergleich zum pränatalen Befund.

Diskussion

Die fetale Obduktion ist trotz verbesserter pränataler Diagnostik auch heute noch von Bedeutung, da sie trotz aller Qualität pränataler Bildgebung nach wie vor klinische Diagnosen in einem signifikanten Prozentsatz von Fällen korrigieren bzw. ergänzen kann.

Abstract

Background

Fetal autopsy rates are decreasing in Western countries although post-mortem examinations render important information for the parents concerning the cause of abortion and risk of recurrence in future pregnancies.

Objective

The intention of the presented study was to analyze the development of fetal autopsies in Germany during the last decade and to review accessible information obtained by fetal autopsy.

Material and methods

Reports of fetal autopsies conducted in two German university Institutes of pathology between 2005 and 2014 were evaluated retrospectively. Demographic data and the correlation between clinical diagnoses and autopsy findings were assessed. In addition, differences between spontaneous and induced cases of abortion and differences between the institutes were also documented.

Results

Overall, 428 fetal autopsies were performed, whereby the number of autopsies decreased by 24.2% during the study period. Of the examined fetuses 29.7% were induced abortions which as expected exhibited different malformations compared to cases of spontaneous abortion (p < 0.001). There was no evidence of a malformation or other cause of death in 27.1% of the cases and 95.7% of these abortions occurred spontaneously. A discrepancy between clinical and autopsy findings was evident in 6.8% of cases and 3.5% of the autopsy examinations revealed at least one additional malformation compared to the prenatal clinical data.

Conclusion

Despite improvements in prenatal diagnostics, fetal autopsies remain an important diagnostic tool even today contributing additional information in a considerable number of cases potentially revising clinical diagnoses.

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Literatur

  1. Addison S, Arthurs OJ, Thayyil S (2014) Post-mortem MRI as an alternative to non-forensic autopsy in foetuses and children: from research into clinical practice. Br J Radiol 87:20130621

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Akolekar R, Beta J, Picciarelli G et al (2015) Procedure-related risk of miscarriage following amniocentesis and chorionic villus sampling: a systematic review and meta-analysis. Ultrasound Obstet Gynecol 45:16–26

    Article  CAS  PubMed  Google Scholar 

  3. Bellad MB, Goudar SS, Edlavitch SA et al (2012) Consanguinity, prematurity, birth weight and pregnancy loss: a prospective cohort study at four primary health center areas of Karnataka, India. J Perinatol 32:431–437

    Article  CAS  PubMed  Google Scholar 

  4. Benn P, Cuckle H, Pergament E (2013) Non-invasive prenatal testing for aneuploidy: current status and future prospects. Ultrasound Obstet Gynecol 42:15–33

    Article  CAS  PubMed  Google Scholar 

  5. Ernst LM (2015) A pathologist’s perspective on the perinatal autopsy. Semin Perinatol 39:55–63

    Article  PubMed  Google Scholar 

  6. Faugstad TM, Brantberg A, Blaas HG et al (2014) Prenatal examination and postmortem findings in fetuses with gastroschisis and omphalocele. Prenat Diagn 34:570–576

    Article  PubMed  Google Scholar 

  7. Giordano G, Fellegara G, Brigati F et al (2011) Value of autopsy in renal malformations: comparison of clinical diagnosis and post-mortem examination. Acta Biomed 82:230–243

    CAS  PubMed  Google Scholar 

  8. Godbole K, Bhide V, Nerune S et al (2014) Role of fetal autopsy as a complementary tool to prenatal ultrasound. J Matern Fetal Neonatal Med 27:1688–1692

    Article  PubMed  Google Scholar 

  9. Goldstein I, Weizman B, Nizar K et al (2014) The nuchal translucency examination leading to early diagnosis of structural fetal anomalies. Early Hum Dev 90:87–91

    Article  PubMed  Google Scholar 

  10. Grande M, Borrell A, Garcia-Posada R et al (2012) The effect of maternal age on chromosomal anomaly rate and spectrum in recurrent miscarriage. Hum Reprod 27:3109–3117

    Article  PubMed  Google Scholar 

  11. Khong TY (1997) Improving perinatal autopsy rates: who is counseling bereaved parents for autopsy consent? Birth 24:55–57

    Article  CAS  PubMed  Google Scholar 

  12. Lomax L, Johansson H, Valentin L et al (2012) Agreement between prenatal ultrasonography and fetal autopsy findings: a retrospective study of second trimester terminations of pregnancy. Ultraschall Med 33:E31–E37

    Article  CAS  PubMed  Google Scholar 

  13. Mchaffie HE, Fowlie PW, Hume R et al (2001) Consent to autopsy for neonates. Arch Dis Child Fetal Neonatal Ed 85:F4–F7

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Mokhtar MM, Abdel-Fattah MM (2001) Consanguinity and advanced maternal age as risk factors for reproductive losses in Alexandria, Egypt. Eur J Epidemiol 17:559–565

    Article  CAS  PubMed  Google Scholar 

  15. Nafziger E, Vilensky JA (2014) The anatomy of nuchal translucency at 10–14 weeks gestation in fetuses with trisomy 21: An incredible medical mystery. Clin Anat 27:353–359

    Article  PubMed  Google Scholar 

  16. O’leary CM, Bower C, Knuiman M et al (2007) Changing risks of stillbirth and neonatal mortality associated with maternal age in Western Australia 1984–2003. Paediatr Perinat Epidemiol 21:541–549

    Article  PubMed  Google Scholar 

  17. Opsjøn BE, Vogt C (2016) Explaining fetal death –what Are the contributions of fetal autopsy and placenta examination? Pediatr Dev Pathol 19:24–30

    Article  PubMed  Google Scholar 

  18. Ramalho C, Brandão O, Monterroso J et al (2012) Cardiac findings in routine fetal autopsies: more than meets the eye? Eur J Obstet Gynecol Reprod Biol 163:142–147

    Article  PubMed  Google Scholar 

  19. Rodriguez MA, Prats P, Rodríguez I et al (2014) Concordance between prenatal ultrasound and autopsy findings in a tertiary center. Prenat Diagn 34:784–789

    Article  PubMed  Google Scholar 

  20. Sarioglu N, Turowski G (2015) Autopsy of children, neonates, fetuses and embryos: preparation, technique and report writing. Pathologe 36:343–354

    Article  CAS  PubMed  Google Scholar 

  21. Simoens E, Hindryckx A, Moerman P et al (2015) Termination of pregnancy for renal malformations. Pediatr Nephrol 30:1443–1449

    Article  PubMed  Google Scholar 

  22. Struksnaes C, Blaas HG, Eik-Nes SH et al (2016) Correlation between prenatal ultrasound and postmortem findings in 1029 fetuses following termination of pregnancy. Ultrasound Obstet Gynecol 48:232–238

    Article  CAS  PubMed  Google Scholar 

  23. Thayyil S, Chitty LS, Robertson NJ et al (2010) Minimally invasive fetal postmortem examination using magnetic resonance imaging and computerised tomography: current evidence and practical issues. Prenat Diagn 30:713–718

    Article  CAS  PubMed  Google Scholar 

  24. Vimercati A, Grasso S, Abruzzese M et al (2012) Correlation between ultrasound diagnosis and autopsy findings of fetal malformations. J Prenat Med 6:13–17

    PubMed  PubMed Central  Google Scholar 

  25. Warland J, O’brien LM, Heazell AE et al (2015) An international internet survey of the experiences of 1,714 mothers with a late stillbirth: the STARS cohort study. BMC Pregnancy Childbirth 15:172

    Article  PubMed  PubMed Central  Google Scholar 

  26. Wou K, Ouellet MP, Chen MF et al (2014) Comparison of the aetiology of stillbirth over five decades in a single centre: a retrospective study. BMJ Open 4:e004635

    Article  PubMed  PubMed Central  Google Scholar 

  27. Zribi M, Makni S, Abid N et al (2013) Fetal cytomegalovirus infection diagnosed on autopsy: a case report. Ann Pathol 33:339–342

    Article  PubMed  Google Scholar 

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Danksagung

Die Autoren danken Dr. med. Hagen Andruszkow für die fachliche Beratung bei Erstellung der statistischen Auswertung.

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Authors and Affiliations

  1. Institut für Pathologie, Uniklinikum der RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Deutschland

    J. Andruszkow, T. Braunschweig & R. Knüchel-Clarke

  2. Institut für Pathologie, Technische Universität München, München, Deutschland

    W. Weichert & F. Erlmeier

  3. Deutsches Konsortium für Translationale Krebsforschung (DKTK), Heidelberg, Deutschland

    W. Weichert

Authors
  1. J. Andruszkow
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  2. W. Weichert
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  3. T. Braunschweig
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  4. R. Knüchel-Clarke
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  5. F. Erlmeier
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Corresponding author

Correspondence to J. Andruszkow.

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Interessenkonflikt

J. Andruszkow, W. Weichert, T. Braunschweig, R. Knüchel-Clarke und F. Erlmeier geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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J. Friemann, Lüdenscheid

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Andruszkow, J., Weichert, W., Braunschweig, T. et al. Fetale Obduktionen. Pathologe 38, 438–447 (2017). https://doi.org/10.1007/s00292-017-0324-7

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  • DOI: https://doi.org/10.1007/s00292-017-0324-7

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