Fetal MRI pp 453-469 | Cite as

Fetal/Perinatal Autopsy and MRI: Synthesis or Alternative?

  • Gabriele Amann
Part of the Medical Radiology book series (MEDRAD)


A complete fetal/perinatal autopsy includes external examination, dissection and examination of internal organs with consecutive histological sampling, microbiological and virological studies as well as the use of sophisticated techniques for cytogenetic and metabolic laboratory investigation. Additional post-mortem X-ray is essential in cases of skeletal abnormalities. Sufficient clinical information and specification of clinical questions is especially important in cases where macroscopic performance may be limited due to small size and/or autolysis. Apart from the most obvious, namely to explain causes and mechanisms of death and disease, the still undisputed manifold benefits obtained from an autopsy in case of fetal perinatal and neonatal death include assurance and improvement of medical quality as well as teaching and research. However, a worldwide decline in autopsy rates over the past decades resulted in a drop of fetal/perinatal autopsies below the level of 75%, which is considered the minimal requirement for quality assurance. Since difficulties in obtaining parenteral consent for a complete autopsy was felt to represent a major reason for this decline, post-mortem MRI was brought up as a possible alternative method, as part of the concept of so called less/minimally invasive autopsies. Systematic and evidence based reviews of studies comparing post-mortem MRI with conventional autopsies however showed that diagnostic accuracy of this method is still insufficient to replace autopsies. Among the reasons for the decline in autopsy rates, misconceptions about autopsies by parents and clinicians are mentioned in the literature. Rehabilitation of the autopsy as a tool of surveillance, teaching and research therefore also seems to require reeducation of the professionals, which should be based on better interdisciplinary communication. On the other hand, places with still adequate autopsy rates, like we have in Vienna, should establish large scale studies, to clearly demonstrate the position pm MRI examination has in the performance of a fetal/perinatal autopsy.


Royal College Postmortem Examination Perinatal Death Urinary Tract Obstruction Brain Malformation 
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.


  1. Wiener Krankenanstaltengesetz 1987 – Wr. KAG, Fassung vom 16.11. 2009, LGB1 Nr 56/2009Google Scholar
  2. Wigglesworth JS (1991) Role of pathology in modern perinatal medicine. In: Wigglesworth JS, Singer DB (eds) Textbook of fetal and perinatal pathology. Blackwell Scientific, Boston, pp 3–9Google Scholar
  3. Khong TY (1996b) A review of perinatal autopsy rates worldwide, 1960s to 1990s. Paediatr Perinat Epidemiol 10(1):97–105, discussion 106–109PubMedCrossRefGoogle Scholar
  4. Gordijin SJ, Erwich JJ, Khong TY (2002) Value of the perinatal autopsy: critique. Pediatr Dev Pathol 5:480–488CrossRefGoogle Scholar
  5. Okah FA (2002) The autopsy: experience of a regional neonatal intensive care unit. Paediatr Perinat Epidemiol 16:350–354PubMedCrossRefGoogle Scholar
  6. Brodlie M, Laing IA, Keeling JW, McKenzie KJ (2002) Ten years of neonatal autopsies in tertiary referral centr: retrospective study. Br Med J 324:761–763CrossRefGoogle Scholar
  7. Kumar P, Angst DB, Taxy J, Mangurten HH (2000 Jan) Neonatal autopsies: a 10-year experience. Arch Pediatr Adolesc Med 154(1):38–42PubMedGoogle Scholar
  8. Adappa R, Paranjothy S, Roberts Z, Cartlidge PH (2007 Jan) Perinatal and infant autopsy. Arch Dis Child Fetal Neonatal Ed 92(1):F49–F50PubMedCrossRefGoogle Scholar
  9. Burton JL, Underwood J (2007) Clinical, educational, and epidemiological value of autopsy. Lancet 369(9571):1471–1480, 28 Apr 2007PubMedCrossRefGoogle Scholar
  10. Cartlidge PH, Dawson AT, Stewart JH, Vujanic GM (1995) Value and quality of perinatal and infant postmortem examinations: cohort analysis of 400 consecutive deaths. BMJ 310(6973):155–158, 21 Jan 1995PubMedCrossRefGoogle Scholar
  11. Khong TY, Turnbull D, Staples A (2001) Provider attitudes about gaining consent for perinatal autopsy. Obstet Gynecol 97(6):994–998PubMedCrossRefGoogle Scholar
  12. Burton JL (2003 Dec) Medical educators’ personal attitudes towards the necropsy. J Clin Pathol 56(12):950–951PubMedCrossRefGoogle Scholar
  13. Snowdon C, Elbourne DR, Garcia J (2004 May) Perinatal pathology in the context of a clinical trial: a review of the literature. Arch Dis Child Fetal Neonatal Ed 89(3):F200–F203PubMedCrossRefGoogle Scholar
  14. Gordijn SJ, Erwich JJ, Khong TY (2007 May) The perinatal autopsy: pertinent issues in multicultural Western Europe. Eur J Obstet Gynecol Reprod Biol 132(1):3–7PubMedCrossRefGoogle Scholar
  15. McDermott M (2004 May) The continuing decline of autopsies in clinical trials: is there any way back? Arch Dis Child Fetal Neonatal Ed 89(3):F198–F199PubMedCrossRefGoogle Scholar
  16. Laing IA (2004) Clinical aspects of neonatal death and autopsy. Semin Neonatol 9:247–254PubMedCrossRefGoogle Scholar
  17. Porter HJ, Keeling JW (1987) Value of perinatal necropsy examination. J Clin Pathol 40:180–184PubMedCrossRefGoogle Scholar
  18. Goldman L, Sayson R, Robbins S, Cohn LH, Bettmann M, Weisberg M (1983) Value of autopsy in three medical areas. N Engl J Med 308:1000–1010PubMedCrossRefGoogle Scholar
  19. Dahms B (1986) The autopsy in pediatrics. Am J Dis Child 140:335PubMedGoogle Scholar
  20. Lundberg GD (1983) Medical students, truth and autopsies. JAMA 50:1199–1200CrossRefGoogle Scholar
  21. Putman MA (2007 Dec) Perinatal perimortem and postmortem examination: obligations and considerations for perinatal, neonatal, and pediatric clinicians. Adv Neonatal Care 7(6):281–288PubMedCrossRefGoogle Scholar
  22. Manchester DK, Pretorius DH, Every C et al (1988) Accuracy of ultrasound diagnosis in pregnancies complicated by suspected fetal anomalies. Prenat Diagn 8:109PubMedCrossRefGoogle Scholar
  23. Boyd PA, Tondi F, Hicks NR, Chamberlain PF (2004) Autopsy after termination of pregnancy for fetal anomaly:retrospective cohort study. BMJ 328:137PubMedCrossRefGoogle Scholar
  24. Dickinson JE, Prime DK, Charles AK (2007 Dec) The role of autopsy following pregnancy termination for fetal abnormality. ANZ J Obstet Gynaecol 47(6):445–449Google Scholar


  1. Khong TY (1996a) The contribution of the pathologist after a perinatal loss: what we should be telling the parents. ANZ J Obstet Gynaecol 36(1):15–17Google Scholar
  2. Kraus FT (2003) Perinatal pathology, the placenta, and litigation. Hum Pathol 34(6):517–521PubMedCrossRefGoogle Scholar
  3. Roberts DJ, Oliva E (2006 May) Clinical significance of placental examination in perinatal medicine. J Matern Fetal Neonatal Med 19(5):255–264PubMedCrossRefGoogle Scholar
  4. Gronvall J, Graem N (1989) Radiography in post-mortem examinations of fetuses and neonates. APMIS 97:274–280PubMedCrossRefGoogle Scholar
  5. van der Harten HJ (2001) The skeletal system. In: Keeling J (ed) Fetal and neonatal pathology. Springer, London, pp 685–709CrossRefGoogle Scholar
  6. Siebert JR (2007) Perinatal, fetal and embryonic autopsy. In: Gilbert-Barnes E (ed) Potter’s pathology of the fetus, infant and child, 2nd edn. Mosby, Philadelphia, pp 695–739Google Scholar
  7. Macpherson TA, Valdes-Dapena M (1998) The perinatal autopsy. In: Wigglesworth JS, Singer DB (eds) Textbook of fetal and perinatal pathology. Blackwell Science, MaldenGoogle Scholar
  8. Kapur RP (2007) Use of ancillary tests in perinatal pathology. In: Gilbert-Barnes E, ed Potter’s Pathology of the Fetus, Infant and Child.2nd Ed Mosby, Philadelphia 2007:871–82Google Scholar
  9. Bendon RW, Coventry S (2004) Non-iatrogenic pathology of the preterm infant. Semin Neonatol 9:281–287PubMedCrossRefGoogle Scholar
  10. Olsen OE (2006 Feb) Radiography following perinatal death: a review. Acta Radiol 47(1):91–99PubMedCrossRefGoogle Scholar
  11. Carroll SG, Porter H, AbdelFattah S, Kyle PM, Soothill PW (2000) Correlation of prenatal ultrasound diagnosis and pathologic findings in fetal brain abnormalities. Ultrasound Obstet Gynecol 16:149–153PubMedCrossRefGoogle Scholar


  1. Dewar S, Boddington P (2004 Oct) Returning to the Alder Hey report and its reporting: addressing confusions and improving inquiries. J Med Ethics 30(5):463–469PubMedCrossRefGoogle Scholar
  2. Joint Working Party of Royal College of Obstetricians and Gynaecologists and Royal College of Pathologists (1988) Report on fetal and perinatal pathology. London: RCOG 1988Google Scholar
  3. Ros PR, Li KC, Vo P, Baer H, Staab EV (1990) Preautopsy magnetic resonance imaging:initial experience. Magn Reson Imaging 8(3):303–308PubMedCrossRefGoogle Scholar
  4. Brookes JA, Hall-Craggs MA, Sams VR, Lees WR (1996) Non-invasive perinatal necropsy by magnetic resonance imaging. Lancet 348(9035):1139–1141, 26 Oct 1996PubMedCrossRefGoogle Scholar
  5. Woodward PJ, Sohaey R, Harris DP, Jackson GM, Klatt EC, Alexander AL, Kennedy A (1997 Jan) Postmortem fetal MR imaging: comparison with findings at autopsy. AJR Am J Roentgenol 168(1):41–46PubMedCrossRefGoogle Scholar
  6. Huisman TA, Wisser J, Stallmach T, Krestin GP, Huch R, Kubik-Huch RA (2002 Jan-Feb) MR autopsy in fetuses. Fetal Diagn Ther 17(1):58–64PubMedCrossRefGoogle Scholar
  7. Alderliesten ME, Peringa J, van der Hulst VP, Blaauwgeers HL, van Lith JM (2003 Apr) Perinatal mortality: clinical value of postmortem magnetic resonance imaging compared with autopsy in routine obstetric practice. BJOG 110(4):378–382PubMedCrossRefGoogle Scholar
  8. Griffiths PD, Variend D, Evans M, Jones A, Wilkinson ID, Paley MN, Whitby E (2003 Jan) Postmortem MR imaging of the fetal and stillborn central nervous system. AJNR Am J Neuroradiol 24(1):22–27PubMedGoogle Scholar
  9. Whitby EH, Paley MN, Cohen M, Griffiths PD (2005 Oct) Postmortem MR imaging of the fetus: an adjunct or a replacement for conventional autopsy? Semin Fetal Neonatal Med 10(5):475–483PubMedCrossRefGoogle Scholar
  10. Griffiths PD, Paley MN, Whitby EH (2005) Post-mortem MRI as an adjunct to fetal or neonatal autopsy. Lancet 365(9466):1271–1273, 2–8 Apr 2005PubMedCrossRefGoogle Scholar
  11. Huisman TA (2004 Aug) Magnetic resonance imaging: an alternative to autopsy in neonatal death? Semin Neonatol 9(4):347–353PubMedCrossRefGoogle Scholar
  12. Brookes JS, Hagmann C (2006 Dec) MRI in fetal necropsy. J Magn Reson Imaging 24(6):1221–1228PubMedCrossRefGoogle Scholar
  13. Whitby EH, Paley MN, Cohen M, Griffiths PD (2006 Feb) Post-mortem fetal MRI: what do we learn from it? Eur J Radiol 57(2):250–255PubMedCrossRefGoogle Scholar
  14. Cohen MC, Paley MN, Griffiths PD, Whitby EH (2008 Jan–Feb) Less invasive autopsy: benefits and limitations of the use of magnetic resonance imaging in the perinatal postmortem. Pediatr Dev Pathol 11(1):1–9PubMedCrossRefGoogle Scholar
  15. Breeze AC, Cross JJ, Hackett GA, Jessop FA, Joubert I, Lomas DJ, Set PA, Whitehead AL, Lees CC (2006 Dec) Use of a confidence scale in reporting postmortem fetal magnetic resonance imaging. Ultrasound Obstet Gynecol 28(7):918–924PubMedCrossRefGoogle Scholar
  16. Thayyil S, Cleary JO, Sebire NJ, Scott RJ, Chong K, Gunny R, Owens CM, Olsen OE, Offiah AC, Parks HG, Chitty LS, Price AN, Yousry TA, Robertson NJ, Lythgoe MF, Taylor AM (2009) Post-mortem examination of human fetuses: a comparison of whole-body high-field MRI at 9.4 T with conventional MRI and invasive autopsy. Lancet 374(9688):467–475, 8 Aug 2009PubMedCrossRefGoogle Scholar
  17. Thayyil S, Chandrasekaran M, Chitty LS, Wade A, Skordis-Worrall J, Bennett-Britton I, Cohen M, Withby E, Sebire NJ, Robertson NJ, Taylor AM (2010 Jul) Diagnostic accuracy of post-mortem magnetic resonance imaging in fetuses, children and adults: a systematic review. Eur J Radiol 75(1):e142–e148PubMedCrossRefGoogle Scholar
  18. Berry PJ, Keeling JW, Wigglesworth JS (1997) Perinatal necropsy by magnetic resonance imaging. Lancet 349(9044):55, 4 Jan 1997, author reply 55–56PubMedCrossRefGoogle Scholar
  19. Whitby E (2009) Minimally invasive autopsy. Lancet 374(9688):432–433, 8 Aug 2009PubMedCrossRefGoogle Scholar
  20. Sebire NJ (2006 Dec) Towards the minimally invasive autopsy? Ultrasound Obstet Gynecol 28(7):865–867PubMedCrossRefGoogle Scholar
  21. Thayyil S (2010) Less invasive autopsy: an evidenced based approach. Arch Dis Child. 1 Jun 2010 [Epub ahead of print]Google Scholar
  22. Lyon A (2004 Jul) Perinatal autopsy remains the “gold standard”. Arch Dis Child Fetal Neonatal Ed 89(4):F284PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2010

Authors and Affiliations

  1. 1.Department of PathologyMedical University of ViennaViennaAustria

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