Cartlidge P H, Dawson A T, Stewart J H, Vujanic G M
University of Wales College of Medicine, Cardiff.
BMJ. 1995 Jan 21;310(6973):155-8. doi: 10.1136/bmj.310.6973.155.
To evaluate the contribution that perinatal and infant necropsy makes to clinical practice and to see how this might be influenced by the quality of the investigation.
Cohort analysis, with data from the all Wales perinatal survey, of perinatal and infant deaths during 1993 of babies born to mothers usually resident in Wales. The clinicopathological classification of death based on clinical details was compared with the classification after necropsy. Similarly, cases in which necropsy yielded new information were identified. The quality of the necropsy was assessed by scoring six aspects of the examination.
400 consecutive deaths at 20 weeks of gestation to 1 year of age.
Necropsy rate, effect of necropsy on clinicopathological classification, new information disclosed by necropsy, quality of necropsies, and the link between new information and quality of the necropsy.
Necropsy was performed in 232 cases (58%). The clinicopathological classification was altered by necropsy in 29 cases (13%). New information was obtained in 60 cases (26%), and in 42 (18%) it disclosed the cause of death. The quality of necropsy was substantially higher when the main cause of death was detected than when nothing new was found.
Necropsy is underused. Clinicians should be more positive about necropsies and realise how much clinically relevant information can be obtained from a good quality examination.
评估围产期及婴儿尸检对临床实践的贡献，并观察其如何受到调查质量的影响。
采用队列分析法，依据全威尔士围产期调查的数据，对1993年常住威尔士的母亲所生婴儿的围产期及婴儿死亡情况进行分析。将基于临床细节的死亡临床病理分类与尸检后的分类进行比较。同样，识别出尸检产生新信息的病例。通过对检查的六个方面进行评分来评估尸检质量。
400例连续发生的妊娠20周直至1岁的死亡病例。
尸检率、尸检对临床病理分类的影响、尸检披露的新信息、尸检质量以及新信息与尸检质量之间的联系。
232例（58%）进行了尸检。29例（13%）的临床病理分类因尸检而改变。60例（26%）获得了新信息，其中42例（18%）揭示了死亡原因。当检测到主要死亡原因时，尸检质量显著高于未发现新情况时。
尸检未得到充分利用。临床医生应对尸检持更积极的态度，并认识到从高质量检查中可获得多少与临床相关的信息。
