Are perinatal autopsy rates satisfactory?

OBJECTIVE

To determine perinatal autopsy rates and whether any maternal or obstetric factors affect consent for autopsy.

DESIGN

Ascertainment of perinatal autopsy rates between 1990 and 1993 for three categories of perinatal deaths: termination of pregnancy for antenatally diagnosed anomalies; fetal deaths and still-births; and neonatal and post-neonatal deaths. A case-control study matched deaths for which consent for autopsy was refused with the next death in the same category for which consent was given.

SETTING

A tertiary maternity hospital in South Australia.

RESULTS

The autopsy rate for pregnancies terminated for fetal abnormalities was 92.4% (171/185) and for intrauterine death was 87.7% (264/301); the rates in these two groups were higher for registrable births (gestation > 20 weeks) than non-registrable births. The overall autopsy rate in liveborn babies was 58.8% (80/136), the neonatal autopsy rate being 59.6% (68/114). No significant differences were found with regard to gestational age at birth, maternal gravidity and parity, employment, health insurance or marital status, or, among liveborn babies, postnatal age, between the autopsy and non-autopsy groups.

CONCLUSIONS

Perinatal autopsy rates are higher than rates in adults but are lower in registrable births than the recommended 75%. Consent for autopsy is the limiting factor. There is a need for a clearer definition of perinatal autopsies, and perinatal autopsy rates, to take into account non-registrable deliveries.