Should Fetal Autopsy Be Performed After a Stillbirth?

Question: Should Fetal Autopsy Be Performed After a Stillbirth?

Answer:

Among the many difficulties parents face following a stillbirth may be the decision of whether to have a fetal autopsy performed on the baby. People have a variety of reactions to this prospect.

You might not feel comfortable with the idea of an autopsy being done on your baby. It's true that knowing why the baby died won't change the fact that it happened.

Parents may have heard that a large percentage of stillbirths are never explained and thus wonder whether there's a point to pursuing an autopsy. But the fact remains that a good percentage of the time, results from a fetal autopsy can make a difference for future pregnancies.

Here's what UpToDate, an online reference for doctors and patients, has to say about the value of fetal autopsy:

"The cause of fetal death can often be determined through gross and histopathologic examination of the fetus and placenta. Determining the cause of death is important because sooner or later parents will want to know "Why did this happen?" and "Will it happen again?" Answers to these questions are often impossible without information gained from pathologic examination.
Findings at perinatal autopsy have been reported to change the clinical diagnosis of the cause of fetal death or yield additional findings in 22 to 76 percent of cases. This new information often influences management of future pregnancies. As an example, a study including 1,477 stillbirths reported that autopsy findings identified the cause of death in 46 percent of cases and yielded new information in 51 percent. This new information changed the estimated recurrence risk in 40 percent of cases, and changed recommendations for preconceptional care in 9 percent, prenatal diagnostic procedures in 21 percent, prenatal management in 7 percent, and neonatal management in 3 percent."

In other words, doctors can sometimes make an educated guess at the cause of death by examining the baby and placenta without an autopsy, but the autopsy will change the initial diagnosis or provide additional important details in between 22% and 76% of the cases. That means an autopsy can uncover information that would otherwise have been missed.

And according to one large study, that information changed the estimated risk of repeat stillbirth nearly half the time. In a smaller but still substantial percentage of cases, information from the fetal autopsy even changed the recommendations for how to manage the mothers' future pregnancies.

Thus, it's safe to say that it is possible that information from a fetal autopsy could change future treatment recommendations.

Here are some common questions about fetal autopsies:

Can there still be a burial if parents agree to an autopsy?

Most of the time, it's still possible to hold a burial after agreeing to an autopsy.

What kind of information will be in the report?

A pathologist will examine the baby's body and some internal organs during the autopsy, which may reveal whether a congenital disorder played a role in the stillbirth. The pathologist will also look closely at the placenta and umbilical cord and will check for evidence of viral or bacterial infections or other abnormalities in the baby's blood.

The report will document any findings or lack thereof.

Will the autopsy always give an answer?

Unfortunately, in the case of stillbirth, there aren't always answers to be had. Not every stillbirth occurs for an obvious reason. But even an autopsy that finds no clear cause of a stillbirth might be valuable in that it might rule out various factors that could affect a future pregnancy.

What are the odds of a repeat stillbirth?

The odds of a repeat stillbirth vary by the individual circumstances. If the autopsy finds a clear cause for the first stillbirth, that cause may or may not be something that tends to recur in future pregnancies. In any case, the report will help the doctor make a better estimate of the risk for the problem recurring and devise a plan for how to minimize the risk if possible.

Want to learn more? See UpToDate's topic, "Evaluation of stillbirth," for additional in-depth medical information.

Source:

Roberts, Drucilla J. "Evaluation of stillbirth." UpToDate. Accessed: April 2010.

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