[Modern fetal autopsy oriented to clinical demands using technical information methods]

[Evaluation of the clinical utility of autopsy: an investigation at the Institute of Pathology, University Hospital of Leipzig]

BACKGROUND

The aim of this study of autopsies performed in our institute was to investigate whether clinical requirements had been met and specific clinical questions answered.

METHOD

With each autopsy report, a questionnaire was sent to the clinic where the patient had died. The clinicians evaluated how often additional diagnoses were made and whether these were clinically relevant.

RESULTS

Seventy-two percent of all autopsies resulted in further diagnoses. Clinicians estimated that these could have influenced their clinical management in 36% of cases. Weaknesses in interdisciplinary cooperation were uncovered and solved.

CONCLUSION

The great benefit of the autopsies conducted in our institute was demonstrated. The results emphasise once again the importance of autopsy for quality assurance in clinical medicine.

Fetal autopsy: a review of recent developments

OBJECTIVE

To analyze recent changes in fetal autopsy in response to developments in prenatal medicine.

METHOD

During the period 1988 through 1997, 783 fetuses (75% induced abortions, 18% spontaneous abortions, and 7% stillbirths, all between the 12th and 40th week of gestation) with prenatally diagnosed congenital malformations and chromosomal aberrations were analyzed. We divided the autopsies into two periods: period A (1988-92, n=370) and period B (1993-97, n=413). All fetuses were analyzed before completion of 20 weeks of gestation. The malformations of the organ systems were presented according to their frequency for fetuses independent of the weeks of gestation.

RESULTS

An autopsy was performed prior to the completion of 20 weeks of gestation for 24% of the fetuses in period A and 45% in period B (P<0.0001). The number of diagnosed congenital heart malformations increased from 16% in period A to 23% in period B. The number of congenital heart malformations before completion of 20 weeks of gestation was only 21% in period A as compared to 42% in period B.

CONCLUSIONS

In period B, clinical questions were raised in a more concrete form and ultrasound images gave more detailed information than in period A. Access to prenatal findings prior to postmortem examination has helped investigators to develop a specific, clinically oriented, autopsy strategy based on the prenatal findings which makes it possible to diagnose very small malformations and to select sectional planes of special interest. The use of an interdisciplinary database is required for communication.

Correlation of prenatal ultrasound diagnosis and morphological findings of fetal autopsy

The findings of prenatal ultrasound diagnosis were compared with the autopsy findings in 183 fetuses (between the 14th and 24th week of gestation), aborted for fetal malformations in the period from 1995 to 1997. In these 183 cases, the primary diagnosis showed 50 central nervous system anomalies, 48 cardiovascular system anomalies, 42 genitourinary system anomalies, 18 respiratory system anomalies, 8 skeleton system anomalies, 6 gastrointestinal system anomalies and 11 other abnormalities. Of the total number of cases, 41% had multiple malformations. In 144 cases (78%), the prenatal diagnosis was confirmed by autopsy, in 36 cases (20%) the prenatal diagnosis was confirmed with additional significant pathology, and in only 3 cases (2%) the prenatally detected malformation was not confirmed by pathological examination. Autopsy remains an important component of the evaluation of fetal losses after induced abortion.