Fetal/Perinatal Autopsy and MRI: Synthesis or Alternative?
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.
KeywordsRoyal College Postmortem Examination Perinatal Death Urinary Tract Obstruction Brain Malformation
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