No. 365-Fetal and Perinatal Autopsy in Prenatally Diagnosed Fetal Abnormalities with Normal Chromosome Analysis

J Obstet Gynaecol Can. 2018 Oct;40(10):1358-1366.e5. doi: 10.1016/j.jogc.2018.05.017.

Abstract

Objective: To review the information on fetal and perinatal autopsies, the process of obtaining consent, and the alternative information-gathering options following a prenatal diagnosis of non-chromosomal anomalies in order to assist health care providers in providing postnatal counselling regarding diagnosis and potential recurrence risks.

Outcomes: To provide better counselling about fetal and perinatal autopsies for women and families who are dealing with a prenatally diagnosed non-chromosomal fetal anomaly.

Evidence: Published literature was retrieved through searches of PubMed or Medline, CINAHL, and The Cochrane Library in 2010, 2011, and 2017, using appropriate key words (fetal autopsy postmortem, autopsy, perinatal postmortem examination, autopsy protocol, postmortem magnetic resonance imaging, autopsy consent, tissue retention, autopsy evaluation). Results were restricted to systematic reviews, randomized controlled trials/controlled clinical trials, and observational studies. Additional publications were identified from the bibliographies of these articles. There were no date or language restrictions. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology assessment-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies.

Benefits, harms, and costs: This update educates readers about (1) the benefits of a fetal perinatal autopsy, (2) the consent process, and (3) the alternatives when the family declines autopsy. It also highlights the need for a standardized approach to fetal and perinatal autopsies, emphasizing pertinent additional sampling when indicated. The authors recognize that there is variability across Canada in access to the cited services and resources. As such, these recommendations were developed in an attempt to promote access and to provide a minimum standard for all provinces and territories across the country.

Values: The quality of evidence was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care (Table).

Keywords: Fetal autopsy; autopsy consent; autopsy evaluation; autopsy protocol; fetal anomalies; perinatal autopsy; perinatal postmortem examination; postmortem MRI; postmortem magnetic resonance imaging; tissue retention.

Publication types

  • Case Reports
  • Practice Guideline

MeSH terms

  • Autopsy*
  • Chromosomes / genetics
  • Congenital Abnormalities* / diagnosis
  • Congenital Abnormalities* / genetics
  • Congenital Abnormalities* / pathology
  • Female
  • Fetus / pathology*
  • Genetic Testing*
  • Humans
  • Pregnancy
  • Prenatal Diagnosis
  • Stillbirth