Provider attitudes about gaining consent for perinatal autopsy
Department of Histopathology, and Division of Paediatric Medicine, Women's and Children's Hospital, Adelaide, Australia. Obstetrics and Gynecology
(Impact Factor: 5.18).
06/2001; 97(6):994-8. DOI: 10.1016/S0029-7844(01)01123-1
To examine the attitudes of neonatologists, obstetricians, midwives, and neonatal nurses toward perinatal autopsy and survey physicians about whom they perceive influence women's decisions on autopsy consent.
A postal survey that incorporated a questionnaire of eight fictitious case scenarios and combined three factors (confidence of antemortem diagnosis, intention to have future pregnancy, and parental attitude toward autopsy) in various permutations was sent to various Australian physicians and nurses (all consultant neonatologists working in neonatal intensive care units and a sample of consultant obstetricians, midwives, and neonatal nurses in level III maternity hospitals). Respondents were asked to rate how likely they were to seek consent for or suggest autopsies on a seven-point Likert scale (1 = certainly will not, 7 = certainly will). Interactions between factors and respondents were measured by analysis of variance, and differences were compared using Mann-Whitney U, chi(2), and generalized estimating equation tests.
The overall response rate was 70% (neonatologists 57%, obstetricians 62%, midwives 77%, and neonatal nurses 75%). Neonatologists (median score 7, interquartile range 7, 7) were more likely to ask for autopsies than neonatal nurses (5; 2, 6) (P <.001), as were obstetricians (7; 7, 7) compared with midwives (6; 3, 7) (P <.001). Physicians rated midwives and neonatal nurses as having some to substantial influence on mothers' decisions about consent for autopsy.
Physicians are not averse to seeking consent for perinatal autopsies. Midwives and nurses are influenced by the three factors studied, which might negatively influence the consent rate for perinatal autopsies. Intervention strategies aimed at changing nurses' attitudes should be considered.
Available from: hu-berlin.de
- "Eine Untersuchung der Plazenta wurde bei 97 Kindern (97%) durchgeführt. Die Einstellung zur Autopsie innerhalb der Ärzteschaft und bei den Hebammen unterliegt unterschiedlichen Einflüssen und ist sehr von der persönlichen Einstellung abhängig (BELLÈE 2000, KHONG 2001 "
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ABSTRACT: Fetal death or stillbirth is a major obstetrical complication and a devastating experience for parents. Health care workers are responsible for investigating the cause of death. Unfortunately, the cause remains unexplained in up to two-thirds of fetal deaths. This is partly influenced by lack of consensus on classification of cause of fetal death and diagnostic investigations into causes. Different aspects of classification systems for cause of perinatal mortality were investigated. In this thesis, the main focus is on optimal investigation of cause of intrauterine antepartum fetal death. Therefore, we studied the value of different diagnostics in allocating the underlying cause. The aim of this thesis was to propose an evidence based guideline for diagnostic work-up after fetal death to determine the cause of death.
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ABSTRACT: 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.
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