Internal Post-Mortem Assessment |
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Internal Post-Mortem Assessment |
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| Considerable information and substantial numbers of
diagnoses will be generated even in those circumstances
where families choose not to have an internal post mortem
evaluation. Nonetheless, internal examination frequently
provides information of a diagnostically critical nature.
Indeed, in the WiSSP series of assessments, internal
postmortem evaluation demonstrated one or more major
abnormalities in 31% of all stillborns. And, in an
unbiased subset of these, analysis suggests that not
completing an internal postmortem evaluation would have
resulted in about 20% of all diagnoses being missed. Most
of the time, the critical diagnostic elements were
identified by gross pathologic evaluation. It is, in
fact, quite uncommon for histologic investigations to
provide etiologically relevant information that would
otherwise remain undiscovered. A variety of resources are available to help guide the general pathologist in the postmortem investigation of a stillborn infant. A guideline for care has been developed by the College of American Pathologists that includes statements regarding the importance of autopsy following stillbirth. This may be of some utility in circumstances (e.g. managed care settings) where such an evaluation must be justified. The full text of this guideline can be found in: Bove KE and the Autopsy Committee of the College of American Pathologists (1997): Practice Guidelines for Autopsy Pathology: The Perinatal and Pediatric Autopsy. Arch Pathol Lab Med 121:368-376. Various protocols and reporting tools have been published. Secondary references that may be particularly helpful to the pathologist who is asked to complete autopsies on stillborn infants include: Gilbert-Barness E (ed.): Potter's Pathology of the Fetus and Infant. St. Louis: Mosby-Year Book, 1997. Wigglesworth JS: Perinatal Pathology. Philadelphia: W.B. Saunders, 1984. Winter RM, Knowles SAS, Bieber FR, Baraitser M: The Malformed Fetus and Stillbirth - A Diagnostic Approach. New York: John Wiley & Sons, 1988. Kalousek DK, Fitch N, Paradice BA: Pathology of the Human Embryo and Previable Fetus. New York: Springer-Verlag, 1990. Placental and Cord Examination < == > Kleihauer-Betke Testing |