Should Fetal Autopsy Be Performed After a Stillbirth?

How to Make a Decision About Autopsy After Pregnancy Loss

woman holding a picture of a baby she lost in stillbirth
What do you need to know about a fetal autopsy after stillbirth?. Istockphoto.com/Stock Photo©FocusOnYou

Should a fetal autopsy be performed after a stillbirth? How often can an autopsy tell you what happened? Could an autopsy give you information that might be important in future pregnancies?

Fetal Autopsy After Stillbirth

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, and the choice is a very personal decision.

Let's take a look at some of the information an autopsy may provide, what an autopsy probably can't tell you, and how often an autopsy can give you information that might help guide you in future pregnancies. Certainly an autopsy can't change the fact that it happened, and some people find it just too difficult to take this step. It's up to you and your partner whatever you choose. There isn't a right or a wrong, only the choice that is best for the two of you alone. That said, it is often the best way to find out how your baby really died.

How Often is a Fetal Autopsy Helpful in Finding a Reason for Stillbirth?

One of the reasons to consider a fetal autopsy is to learn what may have happened. There are many possible causes of a stillbirth. How often can this help? Around half of the time an autopsy can determine the cause of death, and of this half, around 50 percent of the time a fetal autopsy provides information that could not have been found in other ways.

So altogether, about one in four couples will be given an answer through a fetal autopsy that they would otherwise not have had.

How Often Can an Autopsy Give Information Which Affects Risk of Recurrence?

Another very important reason to consider a fetal autopsy is to learn if something happened which could affect your risk that it will happen again.

Studies suggest that a fetal autopsy gives results which change the otherwise expected recurrence risk for a stillbirth up to 40 percent of the time.

How Often Does a Fetal Autopsy Give a Diagnosis Which Was Not Explained Without the Autopsy?

A large 2016 study that a fetal autopsy provided information that was unobtainable by a prenatal ultrasound in around 22 percent of babies lost to miscarriage. The researchers who reported this study felt that a fetal autopsy should be done almost always, as it can unearth additional findings which change the final diagnosis or affect genetic counseling. It's felt by many that a conventional perinatal autopsy is the gold standard for determining the cause of death. Of course, this recommendation was made by physicians and researchers looking at numbers and graphs, and does not mean that parents who have just lost a child need to absolutely do a fetal autopsy.

Can Autopsy Results Change Future Treatment Recommendations?

Many people are not only mourning the loss of the baby, but fear what having a stillbirth may mean with regard to future pregnancies. In contrast, we understand that thinking about future pregnancies is far from the minds of some parents who just lost a child, but it is still important to look at these numbers.

One study looked specifically at the questions of "what could be done differently" in future pregnancies based on the findings during a fetal autopsy. These included:

  • Making a change in prenatal care (9 percent)
  • Adding prenatal diagnostic procedures (21 percent)
  • Changes in prenatal management (7 percent)
  • Changes in newborn management in the next pregnancy (3 percent)

Will an Autopsy Always Give the Answer?

Unfortunately, an autopsy cannot always determine the cause of death. If the autopsy does not find a cause, however, this can still be useful, especially if you are considering getting pregnant in the future.

A negative autopsy does not rule out all conditions which could recur, but it does reduce the chances that an obviously hereditary factor is present.

What Kind of Information Will Be in the Autopsy 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.

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. As noted above, a fetal autopsy can change your expected risk of a recurrence (whether higher or lower) almost half of the time.

Can There Still be a Burial of an Autopsy is Done?

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

Questions to Consider When Making Your Decision

Here are a few questions and comments to consider as you make your decision:

  • Do you desire to know the cause of your baby's death? How strong is your desire? If you don't choose an autopsy now, is there a chance that in the future you will wish you had requested an autopsy?
  • How do you feel about contributing to scientific research? Some people feel very strongly about doing anything that will hasten scientific research even if it will not help them specifically. Others do not feel that contributing to research is worth the emotional pain of having an autopsy done. There is not a right and wrong. The only "right choice" is that which you and your partner are most comfortable with both today and over the long run.
  • Will doing an autopsy and potentially finding more answers help you cope and enhance your well being over the long run? (Certainly this question is hard to ask when you are hurting, but try to think of how you would best be served with regard to coping.)
  • Could having an autopsy done reduce your fear in a future pregnancy?
  • Has your physician talked to you about the respect exhibited at autopsy, and do you feel comfortable that your baby, though no longer present, will be treated with the utmost respect during the procedure?

Bottom Line on Choosing a Fetal Autopsy After Stillbirth

There are pros and cons for doing a fetal autopsy either way. An autopsy may reveal additional details which could be helpful in both determining the cause of your stillbirth, or better managing future pregnancies. At the same time, an autopsy adds additional emotional heartache to what you are already experiencing. Some people have religious reasons as well not to do an autopsy.

Whether you decide to do a fetal autopsy comes down to what is right for you (and your partner) alone (unless there is some reason why an autopsy would be legally mandated, such as for issues of drug abuse.) Don't let anyone push you into doing an autopsy if you are not comfortable and don't let anyone force you to forego the autopsy if it is important to you. Take a moment to think about the questions above. Listen to the input from loved ones. But make the final decision based on what is best for you alone.

Coping after Stillbirth

Regardless of your decision about an autopsy, your physical recovery and emotional recovery after stillbirth are paramount.

Let your friends and family help you. There are several pregnancy loss support organizations which can help provide support as you grieve as well.

Sources:

Arthurs, O., Hutchinson, J., and N. Sebire. Current Issues in Postmorten Imaging of Perinatal and Forensic Childhood Deaths. Forensic Science, Medicine, and Pathology. 2017. 13(1):58-66.

Ernst, L. A Pathologist’s Perspective on the Perinatal Autospy. Seminars in Perinatology. 2015. 39(1):55-63.

Lewis, C., Hill, M., Arthurs, O., Hutchinson, C., Chitty, L., and N Sebire. Factors Affecting Uptake of Postmortem Examination in the Prenatal, Perinatal and Paediatric Setting; A Systematic Review. BCOG. 2017 Feb 11. (Epub ahead of print).

Rossi, A., and F. Prefumo. Correlation Between Fetal Autopsy and Prenatal Diagnosis by Ultrasound: A Systematic Review. European Journal of Obstetrics, Gynecology, and Reproductive Biology. 2016. 210:201-206.

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