Falling rates of perinatal postmortem examination: are we to blame?

Christus St. Michaels' Hospital, 텍사캐나, Arkansas, United States
Archives of Disease in Childhood - Fetal and Neonatal Edition (Impact Factor: 3.86). 12/2006; 91(6):F465. DOI: 10.1136/adc.2005.091314
Source: PubMed
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    ABSTRACT: Stillbirth remains one of the least understood areas of infant death and accurate data on the causes of stillbirth are the cornerstone of stillbirth prevention. An autopsy examination remains the gold standard post-mortem investigation for stillbirth. However, decisions about post-mortem investigations, particularly autopsy are difficult. The purpose of this review is to examine the effectiveness of methods to help parents who have experienced a stillbirth decide whether to have post-mortem investigations, including whether to have an autopsy performed. The primary objectives were a) to examine the effectiveness of interventions to support parents' decisions about autopsy consent after a stillbirth on outcomes for parents, and b) to determine autopsy rates. Secondary objectives were to identify issues related to the acceptability of any interventions to parents and the feasibility of their implementation. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (29 October 2012), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 10), MEDLINE (1966 to 24 July 2012) and EMBASE (1980 to 24 July 2012), Current Controlled Trials metaRegister (mRCT) (18 September 2012) and the WHO International Clinical Trials Registry Platform Search Portal (ICTRP) (18 September 2012). We also searched the websites of the Stillbirth and Neonatal Death Charity (SANDS) and International Stillbirth Alliance (ISA) (18 September 2012) and then subsequently searched the websites of all the ISA member organisations. Randomised controlled trials (RCTs) of interventions designed specifically to support parents who have experienced a stillbirth make decisions about their options for post-mortem investigations including all investigations after stillbirth compared with usual care. Two review authors independently screened citations against the selection criteria. No studies meeting the review inclusion criteria were identified. A search of 40 websites associated with supporting parents who experience stillbirth also found little reference to, or information about autopsy or other post-mortem examinations. Support for parents making decisions about autopsy or other post-mortem examinations after stillbirth must rely on the ad hoc knowledge and experience of those involved at the time.
    Cochrane database of systematic reviews (Online) 01/2013; 2(2):CD009932. DOI:10.1002/14651858.CD009932.pub2 · 5.94 Impact Factor
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    ABSTRACT: Objectives To describe the trend and factors associated with the autopsy over the past decade at a level III neonatal intensive care unit (NICU) where all patients are presented with an option.Study Design Retrospective study of the autopsy in a cohort of infants who died in the NICU from January 1, 2001, to December 31, 2010.Results Of 446 deaths, 33.9% received the autopsy and rates decreased from the 2 years prior to the study. The autopsy was associated with gestational age at birth and chronologic age at death. On multivariable logistic regression analyses, the odds of an autopsy increased with gestational age (p = 0.001), death in the postneonatal period (odds ratio [OR] = 2.01, 95% confidence interval [CI] = 1.28, 3.16), and absence of a major congenital anomaly (OR = 1.96, 95% CI = 1.22, 3.23).Conclusion Autopsy rates continue to decline despite ensuring that all parents are presented with the option. Infants born at term and those who die after 1 month without known congenital anomalies are most likely to receive the autopsy. The persistently low rates may highlight the importance of helping families understand that the autopsy has utility even when the cause of death may appear to be obvious.
    American Journal of Perinatology 01/2013; 30(9). DOI:10.1055/s-0032-1332798 · 1.60 Impact Factor
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    ABSTRACT: Background  Stillbirth, among the most distressing experiences an adult may face, is also a time when parents must decide whether an autopsy or other post-mortem examinations will be performed on their infant. Autopsies can reveal information that might help explain stillbirth, yet little is known about how people make this difficult decision. Objectives  This study examines the influences on decisions about autopsy after stillbirth among Australian parents. Design  The study involved secondary analysis of transcripts of three focus groups using qualitative content analysis. Participants and setting  Seventeen parents of 14 stillborn babies participated in consultations around the revision of a perinatal mortality audit guideline. Results  Parents shared the decision making. Four decision drivers were identified: parents' preparedness or readiness to make decisions; parental responsibility; concern for possible consequences of an autopsy and the role of health professionals. Each decision driver involved reasons both for and against autopsy. Two decision aftermath were also present: some parents who agreed to an autopsy were dissatisfied with the way the autopsy results were given to them and some parents who did not have an autopsy for their infant expressed some form of regret or uncertainty about the choice they made. Conclusions  To make decisions about autopsy after stillbirth, parents need factual information about autopsy procedures, recognition that there might be fear of blame, an environment of trust, and health services and professionals prepared and skilled for difficult conversations.
    Health expectations: an international journal of public participation in health care and health policy 06/2012; DOI:10.1111/j.1369-7625.2012.00782.x · 2.85 Impact Factor