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Gupta N, Langeh N, Sharma A, Mridha A, Jana M, Barwad A, Mani K, Dadhwal V, Kumar A, Deka D, Kabra M. Minimally invasive autopsy in the evaluation of fetal malformations and stillbirths: A feasibility study. Birth Defects Res 2024; 116:e2280. [PMID: 38087877 DOI: 10.1002/bdr2.2280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 09/30/2023] [Accepted: 11/26/2023] [Indexed: 01/27/2024]
Abstract
BACKGROUND Minimally invasive autopsy (MIA) using post-mortem magnetic resonance imaging with ancillary investigations is reported as accurate as conventional autopsy. This study assesses MIA's feasibility and accuracy compared to conventional autopsy. METHOD MIA and/or conventional autopsy were performed on malformed fetuses (14-20 weeks gestation) and stillbirths (>20 weeks gestation), with/without malformation. Concordance in diagnostic accuracy (95% confidence interval [CI]) and agreement (Kappa coefficient [k]) were assessed in malformed cases where both MIA and autopsy were conducted. RESULTS We enrolled 200 cases, including 100 malformed fetuses (<20 weeks) and 100 stillbirths (with/without malformations). Concordance of 97.3% was observed between MIA and autopsy in 156 malformed cases. The overall diagnostic accuracy of MIA was 96.04%. CONCLUSION While conventional autopsy remains the gold standard, MIA is feasible in tertiary care settings. It can be considered a potential alternative for post-mortem assessment, particularly in settings with limited facility of conventional autopsy and parental refusal.
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Affiliation(s)
- Neerja Gupta
- Department of Pediatrics, Division of Genetics, AIIMS, New Delhi, India
| | - Nitika Langeh
- Department of Pediatrics, Division of Genetics, AIIMS, New Delhi, India
| | - Aparna Sharma
- Department of Obstetrics and Gynaecology, AIIMS, New Delhi, India
| | - Asit Mridha
- Department of Pathology, AIIMS, New Delhi, India
| | - Manisha Jana
- Department of Radiodiagnosis, AIIMS, New Delhi, India
| | | | | | - Vatsla Dadhwal
- Department of Obstetrics and Gynaecology, AIIMS, New Delhi, India
| | - Atin Kumar
- Department of Radiodiagnosis, AIIMS, New Delhi, India
| | - Dipika Deka
- Department of Obstetrics and Gynaecology, AIIMS, New Delhi, India
| | - Madhulika Kabra
- Department of Pediatrics, Division of Genetics, AIIMS, New Delhi, India
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2
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Groenendaal F, Nikkels PGJ. Autopsy in a neonatal intensive care unit: do we still need it in 2022? J Pediatr (Rio J) 2022; 98:442-443. [PMID: 35609639 PMCID: PMC9510792 DOI: 10.1016/j.jped.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 05/06/2022] [Indexed: 12/02/2022] Open
Affiliation(s)
- Floris Groenendaal
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands.
| | - Peter G J Nikkels
- Department of Pathology, Wilhelmina Children's Hospital, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands
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3
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Holding a baby after stillbirth: the impact of fetal congenital and structural abnormalities. J Perinatol 2022:10.1038/s41372-022-01480-9. [PMID: 35931797 PMCID: PMC9362406 DOI: 10.1038/s41372-022-01480-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 07/19/2022] [Accepted: 07/25/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Stillbirth can result in numerous adverse psychosocial sequelae. Recommendations vary with regard to holding the baby after a stillbirth. Few studies have addressed the impact of fetal abnormalities on these outcomes. STUDY DESIGN Analyses of singleton stillbirths within the Stillbirth Collaborative Research Network were conducted. Patient and stillbirth characteristics were compared between those who did and did not hold their baby. Results from psychometric surveys were compared between cases with and without visible fetal anomalies. RESULT There were no significant differences between those who held and those who did not hold in any patient or stillborn characteristics. Visible fetal abnormalities were not associated with adverse psychological outcomes. CONCLUSION Fetal abnormalities, including congenital and post-demise changes, do not differ between those who held and did not hold their baby after stillbirth. This suggests that patients should not be discouraged from holding their stillborn infant in the presence of visible abnormalities.
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4
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Ozdemir O, Aksoy F, Sen C. Comparison of prenatal central nervous system abnormalities with postmortem findings in fetuses following termination of pregnancy and clinical utility of postmortem examination. J Perinat Med 2022; 50:769-776. [PMID: 34968018 DOI: 10.1515/jpm-2021-0501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 12/14/2021] [Indexed: 02/04/2023]
Abstract
OBJECTIVES In this study, we aimed to compare prenatal ultrasound (USG) and postmortem examination findings of central nervous system (CNS) abnormalities in fetuses following termination of pregnancy (TOP). METHODS A total of 190 fetuses with USG-confirmed fetal CNS abnormalities of terminated pregnancies between January 2001 and January 2017 were retrospectively analyzed and USG and postmortem examination findings were compared. RESULTS The most frequent CNS abnormalities were acrania/anencephaly (n=45, 24%), spina bifida (n=43, 23%), and ventriculomegaly (n=35, 18%). In 144 of the 190 (76%) cases, there was total agreement between USG and postmortem examination diagnosis. Postmortem examination provided minor findings which did not change the major clinical diagnosis in two (1%) cases with spina bifida and ventriculomegaly. In six (3%) cases, the diagnosis changed after postmortem examination. In 25 of the 190 (13%) cases with multiple abnormalities as evidenced by USG, CNS abnormality was unable to be confirmed at postmortem examination. CONCLUSIONS Our study results show an overall high agreement (76%) between USG and postmortem examination findings for CNS malformations. Due to autolysis and fluid structure, USG-confirmed CNS diagnosis cannot be always confirmed by postmortem examination. This potential discrepancy should be explained to patients before considering TOP. Postmortem examination is the gold standard to confirm prenatal diagnosis.
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Affiliation(s)
- Ozge Ozdemir
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Istanbul University, Cerrahpasa Medical School, Istanbul, Turkey
| | - Figen Aksoy
- Department of Pathology, Istanbul University, Cerrahpasa Medical School, Istanbul, Turkey
| | - Cihat Sen
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Istanbul University, Cerrahpasa Medical School, Istanbul, Turkey
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5
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Lewis C, Hutchinson JC, Riddington M, Hill M, Arthurs OJ, Fisher J, Wade A, Doré CJ, Chitty LS, Sebire NJ. Minimally invasive autopsy for fetuses and children based on a combination of post-mortem MRI and endoscopic examination: a feasibility study. Health Technol Assess 2020; 23:1-104. [PMID: 31461397 DOI: 10.3310/hta23460] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Less invasive perinatal and paediatric autopsy methods, such as imaging alongside targeted endoscopy and organ biopsy, may address declining consent rates for traditional autopsy, but their acceptability and accuracy are not known. OBJECTIVES The aims of this study were to provide empirical data on the acceptability and likely uptake for different types of autopsy among key stakeholders (study 1); and to analyse existing autopsy data sources to provide estimates of the potential efficacy of less invasive autopsy (LIA) and its projected utility in clinical practice (study 2). REVIEW METHODS Study 1: this was a mixed-methods study. Parents were involved in research design and interpretation of findings. Substudy 1: a cross-sectional survey of 859 parents who had experienced miscarriage, termination of pregnancy for fetal anomaly, stillbirth, infant or child death, and interviews with 20 responders. Substudy 2: interviews with 25 health professionals and four coroners. Substudy 3: interviews with 16 religious leaders and eight focus groups, with 76 members of the Muslim and Jewish community. Study 2: a retrospective analysis of national data in addition to detailed information from an existing in-house autopsy database of > 5000 clinical cases that had undergone standard autopsy to determine the proportion of cases by clinical indication group for which tissue sampling of specific internal organs significantly contributed to the diagnosis. RESULTS Substudy 1: 91% of participants indicated that they would consent to some form of LIA, 54% would consent to standard autopsy, 74% to minimally invasive autopsy (MIA) and 77% to non-invasive autopsy (NIA). Substudy 2: participants viewed LIA as a positive development, but had concerns around the limitations of the technology and de-skilling the workforce. Cost implications, skills and training requirements were identified as implementation challenges. Substudy 3: religious leaders agreed that NIA was religiously permissible, but MIA was considered less acceptable. Community members indicated that they might consent to NIA if the body could be returned for burial within 24 hours. Study 2: in 5-10% of cases of sudden unexplained death in childhood and sudden unexplained death in infants, the final cause of death is determined by routine histological sampling of macroscopically normal organs, predominantly the heart and lungs, and in this group routine histological sampling therefore remains an important aspect of investigation. In contrast, routine histological examination of macroscopically normal organs rarely (< 0.5%) provides the cause of death in fetal cases, making LIA and NIA approaches potentially highly applicable. LIMITATIONS A key limitation of the empirical research is that it is hypothetical. Further research is required to determine actual uptake. Furthermore, because of the retrospective nature of the autopsy data set, findings regarding the likely contribution of organ sampling to final diagnosis are based on extrapolation of findings from historical autopsies, and prospective data collection is required to validate the conclusions. CONCLUSIONS LIA is viable and acceptable (except for unexplained deaths), and likely to increase uptake. Further health economic, performance and implementation studies are required to determine the optimal service configuration required to offer this as routine clinical care. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Celine Lewis
- North East Thames Regional Genetics Service, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,Genetics and Genomic Medicine, University College London Great Ormond Street Institute of Child Health, London, UK
| | - John C Hutchinson
- Department of Histopathology, Great Ormond Street Hospital for Children NHS Foundation Trust and Institute of Child Health/University College London, London, UK
| | - Megan Riddington
- Department of Psychological Services, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Melissa Hill
- North East Thames Regional Genetics Service, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,Genetics and Genomic Medicine, University College London Great Ormond Street Institute of Child Health, London, UK
| | - Owen J Arthurs
- Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | | | - Angie Wade
- Institute of Child Health; Population, Policy and Practice, University College London, London, UK
| | - Caroline J Doré
- Comprehensive Clinical Trials Unit, University College London, London, UK
| | - Lyn S Chitty
- North East Thames Regional Genetics Service, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,Genetics and Genomic Medicine, University College London Great Ormond Street Institute of Child Health, London, UK
| | - Neil J Sebire
- Department of Histopathology, Great Ormond Street Hospital for Children NHS Foundation Trust and Institute of Child Health/University College London, London, UK
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The Mortality of Periviable and Extremely Premature Infants and Their Impact on the Overall Neonatal Mortality Rate. Sci Rep 2020; 10:2503. [PMID: 32051505 PMCID: PMC7015938 DOI: 10.1038/s41598-020-59566-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 01/30/2020] [Indexed: 11/08/2022] Open
Abstract
To investigate mortality in periviable neonates ≤23 weeks gestational age and calculate its impact on overall neonatal mortality rate over a 12-year period (1998-2009). Verify if periviable mortality decreased in the period (2010-2015). Retrospective review. Neonatal mortality rate per 1000 live births was 11.4. Three hundred forty-nine live birth infants weighed ≤500 g and 336 died. Their proportion to the total neonatal mortality rate was 48.6%; out of 298 periviables 146 (43%) were ≤20 weeks gestational age. In 269 (80%) we could not determine the cause of death. Two hundred ninety-seven neonates (88.3%) died in the delivery room. Sixteen (5%) had an autopsy. Neonatal mortality rate from periviability was 96.2% and constituted half of the overall rate in the period (1998-2009). There was not significant reduction of periviable mortality between 2010 and 2015. Current live birth definition and a reporting system that considers a 100 g periviable live birth infant as a neonatal death has placed Ohio and the United States at a significant disadvantage compared to other countries using different reporting systems.
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Sauvegrain P, Carayol M, Piedvache A, Guéry E, Bucourt M, Zeitlin J. Low autopsy acceptance after stillbirth in a disadvantaged French district: a mixed methods study. BMC Pregnancy Childbirth 2019; 19:117. [PMID: 30953470 PMCID: PMC6451265 DOI: 10.1186/s12884-019-2261-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 03/25/2019] [Indexed: 11/11/2022] Open
Affiliation(s)
- Priscille Sauvegrain
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Maternité de Port Royal, 53, av. de l’Observatoire, 75014 Paris, France
- Department of Obstetrics and Gynecology, Pitié-Salpêtrière Hospital, AP-HP, Paris, France
| | - Marion Carayol
- Maternal and Infant Protection Service, Department of Families and Early Childhood, Paris, France
| | - Aurélie Piedvache
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Maternité de Port Royal, 53, av. de l’Observatoire, 75014 Paris, France
| | - Esther Guéry
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Maternité de Port Royal, 53, av. de l’Observatoire, 75014 Paris, France
| | - Martine Bucourt
- Fetopathology Unit, Jean Verdier Hospital, AP-HP, Bondy, France
| | - Jennifer Zeitlin
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Maternité de Port Royal, 53, av. de l’Observatoire, 75014 Paris, France
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8
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Auger N, Bilodeau-Bertrand M, Costopoulos A. Emerging Lingo-Cultural Inequality in Infant Autopsy in Quebec, Canada. J Immigr Minor Health 2018; 21:230-236. [PMID: 29774511 DOI: 10.1007/s10903-018-0756-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We investigated trends in infant autopsy for Francophones and Anglophones in Quebec, Canada. Using death certificates, we extracted 8214 infant deaths between 1989 and 2013. We computed rates of non-autopsy by language, socioeconomic disadvantage, age at death, and period. Using Kitagawa's method, we decomposed non-autopsy rates over time for both language groups. Infant non-autopsy rates increased from 38.6 to 56.2 per 100 for Francophones, and from 41.2 to 57.2 per 100 for Anglophones, between 1989-1995 and 2008-2013. Trends in English-speakers were driven by socioeconomically disadvantaged Anglophones, and were accelerated by a larger proportion of deaths in this group over time. For French-speakers, rates increased in all socioeconomic groups. The increase in non-autopsy rates was larger at early neonatal ages for both languages. These findings suggest that disadvantaged Anglophones are less likely to use infant autopsy over time, and that rates can be improved by targeting early neonatal deaths.
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Affiliation(s)
- Nathalie Auger
- University of Montreal Hospital Research Centre, 900 Saint-Denis, Montreal, QC, H2X 0A9, Canada. .,Institut national de santé publique du Québec, 190 Crémazie E. Blvd., Montreal, QC, H2P 1E2, Canada.
| | - Marianne Bilodeau-Bertrand
- University of Montreal Hospital Research Centre, 900 Saint-Denis, Montreal, QC, H2X 0A9, Canada.,Institut national de santé publique du Québec, 190 Crémazie E. Blvd., Montreal, QC, H2P 1E2, Canada
| | - André Costopoulos
- Department of Anthropology, University of Alberta, 13-15 HM Tory Building, Edmonton, AB, T6G 2H4, Canada
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9
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Wojcieszek AM, Shepherd E, Middleton P, Gardener G, Ellwood DA, McClure EM, Gold KJ, Khong TY, Silver RM, Erwich JJHM, Flenady V. Interventions for investigating and identifying the causes of stillbirth. Cochrane Database Syst Rev 2018; 4:CD012504. [PMID: 29709055 PMCID: PMC6494629 DOI: 10.1002/14651858.cd012504.pub2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Identification of the causes of stillbirth is critical to the primary prevention of stillbirth and to the provision of optimal care in subsequent pregnancies. A wide variety of investigations are available, but there is currently no consensus on the optimal approach. Given their cost and potential to add further emotional burden to parents, there is a need to systematically assess the effect of these interventions on outcomes for parents, including psychosocial outcomes, economic costs, and on rates of diagnosis of the causes of stillbirth. OBJECTIVES To assess the effect of different tests, protocols or guidelines for investigating and identifying the causes of stillbirth on outcomes for parents, including psychosocial outcomes, economic costs, and rates of diagnosis of the causes of stillbirth. SEARCH METHODS We searched Cochrane Pregnancy and Childbirth's Trials Register (31 August 2017), ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform (ICTRP) (15 May 2017). SELECTION CRITERIA We planned to include randomised controlled trials (RCTs), quasi-RCTs, and cluster-RCTs. We planned to include studies published as abstract only, provided there was sufficient information to allow us to assess study eligibility. We planned to exclude cross-over trials.Participants included parents (including mothers, fathers, and partners) who had experienced a stillbirth of 20 weeks' gestation or greater.This review focused on interventions for investigating and identifying the causes of stillbirth. Such interventions are likely to be diverse, but could include:* review of maternal and family history, and current pregnancy and birth history;* clinical history of present illness;* maternal investigations (such as ultrasound, amniocentesis, antibody screening, etc.);* examination of the stillborn baby (including full autopsy, partial autopsy or noninvasive components, such as magnetic resonance imaging (MRI), computerised tomography (CT) scanning, and radiography);* umbilical cord examination;* placental examination including histopathology (microscopic examination of placental tissue); and* verbal autopsy (interviews with care providers and support people to ascertain causes, without examination of the baby).We planned to include trials assessing any test, protocol or guideline (or combinations of tests/protocols/guidelines) for investigating the causes of stillbirth, compared with the absence of a test, protocol or guideline, or usual care (further details are presented in the Background, see Description of the intervention).We also planned to include trials comparing any test, protocol or guideline (or combinations of tests/protocols/guidelines) for investigating the causes of stillbirth with another, for example, the use of a limited investigation protocol compared with a comprehensive investigation protocol. DATA COLLECTION AND ANALYSIS Two review authors assessed trial eligibility independently. MAIN RESULTS We excluded five studies that were not RCTs. There were no eligible trials for inclusion in this review. AUTHORS' CONCLUSIONS There is currently a lack of RCT evidence regarding the effectiveness of interventions for investigating and identifying the causes of stillbirth. Seeking to determine the causes of stillbirth is an essential component of quality maternity care, but it remains unclear what impact these interventions have on the psychosocial outcomes of parents and families, the rates of diagnosis of the causes of stillbirth, and the care and management of subsequent pregnancies following stillbirth. Due to the absence of trials, this review is unable to inform clinical practice regarding the investigation of stillbirths, and the specific investigations that would determine the causes.Future RCTs addressing this research question would be beneficial, but the settings in which the trials take place, and their design, need to be given careful consideration. Trials need to be conducted with the utmost care and consideration for the needs, concerns, and values of parents and families. Assessment of longer-term psychosocial variables, economic costs to health services, and effects on subsequent pregnancy care and outcomes should also be considered in any future trials.
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Affiliation(s)
- Aleena M Wojcieszek
- Mater Research Institute ‐ The University of Queensland (MRI‐UQ)NHMRC Centre of Research Excellence in StillbirthLevel 3 Aubigny PlaceMater Health ServicesBrisbaneQueenslandAustralia4101
| | - Emily Shepherd
- The University of AdelaideARCH: Australian Research Centre for Health of Women and Babies, Robinson Research Institute, Discipline of Obstetrics and GynaecologyAdelaideSouth AustraliaAustralia5006
| | - Philippa Middleton
- Healthy Mothers, Babies and Children, South Australian Health and Medical Research InstituteWomen's and Children's Hospital72 King William RoadAdelaideSouth AustraliaAustralia5006
| | - Glenn Gardener
- Mater Mothers' HospitalDepartment of Maternal Fetal MedicineRaymond TerraceBrisbaneQueenslandAustralia4101
| | - David A Ellwood
- Griffith UniversitySchool of MedicineGold Coast CampusLevel 8, G40Gold CoastQueensland,Australia4216
| | - Elizabeth M McClure
- Research Triangle InstituteDepartment of Maternal and Child Health3040 East Cornwallis RoadResearch Triangle ParkNCUSA27709
| | - Katherine J Gold
- University of MichiganDepartment of Family Medicine; Department of Obstetrics and Gynecology1018 Fuller StreetAnn ArborMichiganUSA48104 1213
| | - Teck Yee Khong
- Women's and Children's HospitalSA Pathology72 King William RoadAdelaideSouth AustraliaAustralia5006
| | - Robert M Silver
- University of UtahDivision of Maternal‐Fetal Medicine, Health Services Center30 North 1900 East SOM 2B200Salt Lake CityUtahUSA84132
| | - Jan Jaap HM Erwich
- University of Groningen, University Medical Center GroningenDepartment of Obstetrics and GynecologyHanzeplein 1GroningenNetherlands9700 RB
| | - Vicki Flenady
- Mater Research Institute ‐ The University of Queensland (MRI‐UQ)NHMRC Centre of Research Excellence in StillbirthLevel 3 Aubigny PlaceMater Health ServicesBrisbaneQueenslandAustralia4101
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10
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Alhawari Y, Verhoff MA, Parzeller M. Hirntod, Organtransplantation und Obduktion aus der Sicht der Weltreligionen. Rechtsmedizin (Berl) 2018. [DOI: 10.1007/s00194-018-0243-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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12
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Neşe N, Bülbül Y. Diagnostic value of perinatal autopsies: analysis of 486 cases. J Perinat Med 2018; 46:175-181. [PMID: 28841576 DOI: 10.1515/jpm-2016-0396] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 05/26/2017] [Indexed: 11/15/2022]
Abstract
AIM Autopsy is a beneficial procedure to determine the cause of death and the frequency of anomalies in perinatal losses. Even in the event of an autopsy not providing any additional information, completion of the procedure confirming the clinical diagnoses gives reassurance to both clinicians and parents. Here we present a 15-year archival study based on findings of perinatal autopsies. DESIGN AND METHODS Four hundred and eighty-six cases from our archive were reviewed and according to the findings they were divided into three subcategories; (1) miscarriages (MCF); (2) fetuses terminated (FTA) for vital anomalies detected by prenatal ultrasonography; (3) premature or term newborns died within first month of life (neonates: NN). Autopsies were documented and classified according to week/age of cases, anomalies and causes of abortion or death. RESULTS Two hundred and twenty-six of 486 cases (46.5%) were in MCF group while 227 (46.7%) and 33 (6.8%) were of them in FTA and NN groups, respectively. In FTA group, the most frequent anomaly detected was neural tube defects. In NN group, prematurity related complications were the most common cause of death. The autopsy process was found valuable in 39.7% of all cases. CONCLUSIONS We suggest that autopsy procedure is diagnostically valuable even in situations when there is USG findings that are confirming FTAs or there is no important major fetal or placental anomaly detected in MCFs.
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Affiliation(s)
- Nalan Neşe
- Department of Pathology, Faculty of Medicine, Celal Bayar University, Manisa 45030, Turkey, Tel.: +90-236-4444228/1614, Fax: +90-236-2338040
| | - Yeşim Bülbül
- Department of Obstetrics and Gynecology, Faculty of Medicine, Celal Bayar University, Manisa, Turkey
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13
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Wojcieszek AM, Shepherd E, Middleton P, Gardener G, Ellwood DA, McClure EM, Gold KJ, Khong TY, Silver RM, Erwich JJHM, Flenady V. Interventions for investigating and identifying the causes of stillbirth. Hippokratia 2017. [DOI: 10.1002/14651858.cd012504] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Aleena M Wojcieszek
- Mater Research Institute - The University of Queensland (MRI-UQ); Stillbirth Research Team; Level 2 Aubigny Place Mater Health Services Brisbane Queensland Australia 4101
| | - Emily Shepherd
- The University of Adelaide; ARCH: Australian Research Centre for Health of Women and Babies, Robinson Research Institute, Discipline of Obstetrics and Gynaecology; Adelaide South Australia Australia 5006
| | - Philippa Middleton
- Healthy Mothers, Babies and Children, South Australian Health and Medical Research Institute; Women's and Children's Hospital 72 King William Road Adelaide South Australia Australia 5006
| | - Glenn Gardener
- Mater Mothers' Hospital; Department of Maternal Fetal Medicine; Raymond Terrace Brisbane Queensland Australia 4101
| | - David A Ellwood
- Griffith University; School of Medicine; Gold Coast Campus Level 8, G40 Gold Coast Queensland, Australia 4216
| | - Elizabeth M McClure
- Research Triangle Institute; Department of Maternal and Child Health; 3040 East Cornwallis Road Research Triangle Park NC USA 27709
| | - Katherine J Gold
- University of Michigan; Department of Family Medicine; Department of Obstetrics and Gynecology; 1018 Fuller Street Ann Arbor Michigan USA 48104 1213
| | - Teck Yee Khong
- Women's and Children's Hospital; SA Pathology; 72 King William Road Adelaide South Australia Australia 5006
| | - Robert M Silver
- University of Utah; Division of Maternal-Fetal Medicine, Health Services Center; 30 North 1900 East SOM 2B200 Salt Lake City Utah USA 84132
| | - Jan Jaap HM Erwich
- Rijks Universiteit Groningen; Department of Obstetrics and Gynecology; Hanzeplein 1 Groningen Netherlands 9700 RB
| | - Vicki Flenady
- Mater Research Institute - The University of Queensland (MRI-UQ); Stillbirth Research Team; Level 2 Aubigny Place Mater Health Services Brisbane Queensland Australia 4101
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14
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Maixenchs M, Anselmo R, Zielinski-Gutiérrez E, Odhiambo FO, Akello C, Ondire M, Zaidi SSH, Soofi SB, Bhutta ZA, Diarra K, Djitèye M, Dembélé R, Sow S, Minsoko PCA, Agnandji ST, Lell B, Ismail MR, Carrilho C, Ordi J, Menéndez C, Bassat Q, Munguambe K. Willingness to Know the Cause of Death and Hypothetical Acceptability of the Minimally Invasive Autopsy in Six Diverse African and Asian Settings: A Mixed Methods Socio-Behavioural Study. PLoS Med 2016; 13:e1002172. [PMID: 27875532 PMCID: PMC5119724 DOI: 10.1371/journal.pmed.1002172] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 10/11/2016] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The minimally invasive autopsy (MIA) is being investigated as an alternative to complete diagnostic autopsies for cause of death (CoD) investigation. Before potential implementation of the MIA in settings where post-mortem procedures are unusual, a thorough assessment of its feasibility and acceptability is essential. METHODS AND FINDINGS We conducted a socio-behavioural study at the community level to understand local attitudes and perceptions related to death and the hypothetical feasibility and acceptability of conducting MIAs in six distinct settings in Gabon, Kenya, Mali, Mozambique, and Pakistan. A total of 504 interviews (135 key informants, 175 health providers [including formal health professionals and traditional or informal health providers], and 194 relatives of deceased people) were conducted. The constructs "willingness to know the CoD" and "hypothetical acceptability of MIAs" were quantified and analysed using the framework analysis approach to compare the occurrence of themes related to acceptability across participants. Overall, 75% (379/504) of the participants would be willing to know the CoD of a relative. The overall hypothetical acceptability of MIA on a relative was 73% (366/504). The idea of the MIA was acceptable because of its perceived simplicity and rapidity and particularly for not "mutilating" the body. Further, MIAs were believed to help prevent infectious diseases, address hereditary diseases, clarify the CoD, and avoid witchcraft accusations and conflicts within families. The main concerns regarding the procedure included the potential breach of confidentiality on the CoD, the misperception of organ removal, and the incompatibility with some religious beliefs. Formal health professionals were concerned about possible contradictions between the MIA findings and the clinical pre-mortem diagnoses. Acceptability of the MIA was equally high among Christian and Islamic communities. However, in the two predominantly Muslim countries, MIA acceptability was higher in Mali than in Pakistan. While the results of the study are encouraging for the potential use of the MIA for CoD investigation in low-income settings, they remain hypothetical, with a need for confirmation with real-life MIA implementation and in populations beyond Health and Demographic Surveillance System areas. CONCLUSIONS This study showed a high level of interest in knowing the CoD of a relative and a high hypothetical acceptability of MIAs as a tool for CoD investigation across six distinct settings. These findings anticipate potential barriers and facilitators, both at the health facility and community level, essential for local tailoring of recommendations for future MIA implementation.
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Affiliation(s)
- Maria Maixenchs
- Centro de Investigação em Saúde da Manhiça, Maputo, Mozambique
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Rui Anselmo
- Centro de Investigação em Saúde da Manhiça, Maputo, Mozambique
| | | | - Frank O. Odhiambo
- Kenya Medical Research Institute, Centre for Global Health Research, Kisumu, Kenya
| | - Clarah Akello
- Kenya Medical Research Institute, Centre for Global Health Research, Kisumu, Kenya
| | - Maureen Ondire
- Kenya Medical Research Institute, Centre for Global Health Research, Kisumu, Kenya
| | - S. Shujaat H. Zaidi
- Centre of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Sajid Bashir Soofi
- Centre of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Zulfiqar A. Bhutta
- Centre of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Kounandji Diarra
- Centre pour le Développement des Vaccins (CVD-Mali), Bamako, Mali
| | - Mahamane Djitèye
- Centre pour le Développement des Vaccins (CVD-Mali), Bamako, Mali
| | | | - Samba Sow
- Centre pour le Développement des Vaccins (CVD-Mali), Bamako, Mali
| | | | - Selidji Todagbe Agnandji
- Centre de Recherches Médicales de Lambaréné, Hôpital Albert Schweitzer, Lambaréné, Gabon
- Institut für Tropenmedizin, Universitätsklinikum Tübingen, Tübingen, Germany
| | - Bertrand Lell
- Centre de Recherches Médicales de Lambaréné, Hôpital Albert Schweitzer, Lambaréné, Gabon
- Institut für Tropenmedizin, Universitätsklinikum Tübingen, Tübingen, Germany
| | - Mamudo R. Ismail
- Department of Pathology, Maputo Central Hospital, Maputo, Mozambique
- Catalan Institution for Research and Advanced Studies (ICREA), Barcelona, Spain
| | - Carla Carrilho
- Department of Pathology, Maputo Central Hospital, Maputo, Mozambique
- Catalan Institution for Research and Advanced Studies (ICREA), Barcelona, Spain
| | - Jaume Ordi
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Clara Menéndez
- Centro de Investigação em Saúde da Manhiça, Maputo, Mozambique
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Quique Bassat
- Centro de Investigação em Saúde da Manhiça, Maputo, Mozambique
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
- Catalan Institution for Research and Advanced Studies (ICREA), Barcelona, Spain
| | - Khátia Munguambe
- Centro de Investigação em Saúde da Manhiça, Maputo, Mozambique
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
- * E-mail:
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Connolly AJ, Finkbeiner WE, Ursell PC, Davis RL. Legal, Social, and Ethical Issues. AUTOPSY PATHOLOGY: A MANUAL AND ATLAS 2016. [PMCID: PMC7161399 DOI: 10.1016/b978-0-323-28780-7.00002-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Allotey PA, Reidpath DD, Evans NC, Devarajan N, Rajagobal K, Bachok R, Komahan K. Let's talk about death: data collection for verbal autopsies in a demographic and health surveillance site in Malaysia. Glob Health Action 2015; 8:28219. [PMID: 26140728 PMCID: PMC4490796 DOI: 10.3402/gha.v8.28219] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2015] [Revised: 05/25/2015] [Accepted: 06/08/2015] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Verbal autopsies have gained considerable ground as an acceptable alternative to medically determined cause of death. Unlike with clinical or more administrative settings for data collection, verbal autopsies require significant involvement of families and communities, which introduces important social and cultural considerations. However, there is very little clear guidance about the methodological issues in data collection. The objectives of this case study were: to explore the range of bereavement rituals within the multi-ethnic, multi-faith population of the district; to investigate the preparedness of communities to talk about death; to describe the verbal autopsy process; to assess the effects of collecting verbal autopsy data on data collectors; and to determine the most accurate sources of information about deaths in the community. METHODS A case study approach was used, using focus group discussions, indepth interviews and field notes. Thematic analyses were undertaken using NVivo. RESULTS Consideration of cultural bereavement practices is importance to acceptance and response rates to verbal autopsies. They are also important to the timing of verbal autopsy interviews. Well trained data collectors, regardless of health qualifications are able to collect good quality data, but debriefing is important to their health and well being. This article contributes to guidance on the data collection procedures for verbal autopsies within community settings.
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Affiliation(s)
- Pascale A Allotey
- South East Asia Community Observatory (SEACO), Monash University, Segamat, Malaysia
- Global Public Health, School of Medicine and Health Sciences, Monash University, Malaysia;
| | - Daniel D Reidpath
- South East Asia Community Observatory (SEACO), Monash University, Segamat, Malaysia
- Global Public Health, School of Medicine and Health Sciences, Monash University, Malaysia
| | - Natalie C Evans
- South East Asia Community Observatory (SEACO), Monash University, Segamat, Malaysia
- Amsterdam Institute for Social Science Research (AISSR), University of Amsterdam, Amsterdam, the Netherlands
| | - Nirmala Devarajan
- South East Asia Community Observatory (SEACO), Monash University, Segamat, Malaysia
| | - Kanason Rajagobal
- South East Asia Community Observatory (SEACO), Monash University, Segamat, Malaysia
- Global Public Health, School of Medicine and Health Sciences, Monash University, Malaysia
| | - Ruhaida Bachok
- South East Asia Community Observatory (SEACO), Monash University, Segamat, Malaysia
| | - Kridaraan Komahan
- South East Asia Community Observatory (SEACO), Monash University, Segamat, Malaysia
- Global Public Health, School of Medicine and Health Sciences, Monash University, Malaysia
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Addison S, Arthurs OJ, Thayyil S. Post-mortem MRI as an alternative to non-forensic autopsy in foetuses and children: from research into clinical practice. Br J Radiol 2014; 87:20130621. [PMID: 24288400 DOI: 10.1259/bjr.20130621] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Although post-mortem MRI (PMMR) was proposed as an alternative to conventional autopsy more than a decade ago, the lack of systematic validation has limited its clinical uptake. Minimally invasive autopsy (MIA) using PMMR together with ancillary investigations has now been shown to be as accurate as conventional autopsy in foetuses, newborns and infants and is particularly useful for cerebral, cardiac and genitourinary imaging. Unlike conventional autopsy, PMMR provides a permanent three-dimensional auditable record, with accurate estimation of internal organ volumes. MIA is becoming highly acceptable to parents and professionals, and there is widespread political support and public interest in its clinical implementation in the UK. In the short to medium term, it is desirable that a supraregional network of specialist centres should be established to provide this service within the current National Health Service framework.
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Affiliation(s)
- S Addison
- Perinatal Neurology and Neonatology, Imperial College London, London, UK
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18
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Meaney S, Gallagher S, Lutomski JE, O'Donoghue K. Parental decision making around perinatal autopsy: a qualitative investigation. Health Expect 2014; 18:3160-71. [PMID: 25376775 DOI: 10.1111/hex.12305] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2014] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Decades of decline in uptake rates of perinatal autopsies has limited investigation into the causes and risk factors for stillbirth. AIMS This study aimed to qualitatively explore perinatal autopsy decision-making processes in parents who experienced antepartum and intrapartum stillbirths. MATERIAL AND METHODS A qualitative semi-structured interview format was utilized. The line of questioning centred on how parents came to decide on consenting or declining to have a perinatal autopsy undertaken. Interpretative phenomenological analysis was employed as the analytic strategy. Purposive sampling was used to recruit 10 parents who either consented or declined autopsy from a large tertiary maternity hospital in Cork Ireland, where there were 30 stillbirths in 2011. RESULTS Findings revealed four superordinate themes influencing parents' decision-making which varied with type of stillbirth experienced. Those parents who experienced antepartum stillbirths were more likely to consent; thus, knowing that the child was stillborn prior to delivery rather than on the day of delivery was associated with consent. In fact, these parents had more time for meaning-making; those consenting wanted to rule out self-blame and were fearful about future pregnancies. Parents who declined autopsy wanted to protect their infant from further harm. Interestingly, parents' knowledge and understanding of the autopsy itself were acquired primarily from public discourse. CONCLUSION Parents' decision-making regarding autopsy is profoundly affected by their emotional response to stillbirth; clinicians and other health professionals may play a key role, especially if they can address parental concerns regarding the invasiveness of the autopsy procedure.
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Affiliation(s)
- Sarah Meaney
- National Perinatal Epidemiology Centre, University College Cork, Cork, Ireland
| | - Stephen Gallagher
- Centre for Social Issues Research, Department of Psychology, University of Limerick, Limerick, Ireland
| | - Jennifer E Lutomski
- National Perinatal Epidemiology Centre, University College Cork, Cork, Ireland.,Nijmegen Centre for Evidence Based Practice, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Keelin O'Donoghue
- Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland
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Eskes M, Waelput AJM, Erwich JJHM, Brouwers HAA, Ravelli ACJ, Achterberg PW, Merkus H(JMWM, Bruinse HW. Term perinatal mortality audit in the Netherlands 2010-2012: a population-based cohort study. BMJ Open 2014; 4:e005652. [PMID: 25763794 PMCID: PMC4202001 DOI: 10.1136/bmjopen-2014-005652] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To assess the implementation and first results of a term perinatal internal audit by a standardised method. DESIGN Population-based cohort study. SETTING All 90 Dutch hospitals with obstetric/paediatric departments linked to community practices of midwives, general practitioners in their attachment areas, organised in perinatal cooperation groups (PCG). POPULATION The population consisted of 943 registered term perinatal deaths occurring in 2010-2012 with detailed information, including 707 cases with completed audit results. MAIN OUTCOME MEASURES Participation in the audit, perinatal death classification, identification of substandard factors (SSF), SSF in relation to death, conclusive recommendations for quality improvement in perinatal care and antepartum risk selection at the start of labour. RESULTS After the introduction of the perinatal audit in 2010, all PCGs participated. They organised 645 audit sessions, with an average of 31 healthcare professionals per session. Of all 1102 term perinatal deaths (2.3/1000) data were registered for 86% (943) and standardised anonymised audit results for 64% (707). In 53% of the cases at least one SSF was identified. Non-compliance to guidelines (35%) and deviation from usual professional care (41%) were the most frequent SSF. There was a (very) probable relation between the SSF and perinatal death for 8% of all cases. This declined over the years: from 10% (n=23) in 2010 to 5% (n=10) in 2012 (p=0.060). Simultaneously term perinatal mortality decreased from 2.3 to 2.0/1000 births (p<0.00001). Possibilities for improvement were identified in the organisation of care (35%), guidelines or usual care (19%) and in documentation (15%). More pregnancies were antepartum selected as high risk, 70% in 2010 and 84% in 2012 (p=0.0001). CONCLUSIONS The perinatal audit is implemented nationwide in all obstetrical units in the Netherlands in a short time period. It is possible that the audit contributed to the decrease in term perinatal mortality.
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Affiliation(s)
- Martine Eskes
- Foundation Perinatal Audit in The Netherlands (PAN), Utrecht, The Netherlands
- Department of Medical Informatics, Academic Medical Center, Amsterdam, The Netherlands
| | - Adja J M Waelput
- Foundation Perinatal Audit in The Netherlands (PAN), Utrecht, The Netherlands
| | - Jan Jaap H M Erwich
- Department of Obstetrics and Gynaecology, University of Groningen, Groningen, The Netherlands
| | - Hens A A Brouwers
- Department of Neonatology, University Medical Center, Utrecht, The Netherlands
| | - Anita C J Ravelli
- Department of Medical Informatics, Academic Medical Center, Amsterdam, The Netherlands
| | - Peter W Achterberg
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | | | - Hein W Bruinse
- Foundation Perinatal Audit in The Netherlands (PAN), Utrecht, The Netherlands
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Affiliation(s)
- Corinne L Fligner
- Departments of Pathology and Laboratory Medicine, University of Washington, Seattle, WA 98195, USA.
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Racape J, De Spiegelaere M, Dramaix M, Haelterman E, Alexander S. Effect of adopting host-country nationality on perinatal mortality rates and causes among immigrants in Brussels. Eur J Obstet Gynecol Reprod Biol 2013; 168:145-50. [DOI: 10.1016/j.ejogrb.2012.12.039] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Revised: 12/18/2012] [Accepted: 12/22/2012] [Indexed: 11/25/2022]
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Horey D, Flenady V, Heazell AEP, Khong TY. Interventions for supporting parents' decisions about autopsy after stillbirth. Cochrane Database Syst Rev 2013:CD009932. [PMID: 23450611 DOI: 10.1002/14651858.cd009932.pub2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND 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. OBJECTIVES 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. SEARCH METHODS 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. SELECTION CRITERIA 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. DATA COLLECTION AND ANALYSIS Two review authors independently screened citations against the selection criteria. MAIN RESULTS 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. AUTHORS' CONCLUSIONS 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.
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Affiliation(s)
- Dell Horey
- Faculty of Health Sciences, La Trobe University, Bundoora, Australia.
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Banyini AV, Rees D, Gilbert L. "Even if I were to consent, my family will never agree": exploring autopsy services for posthumous occupational lung disease compensation among mineworkers in South Africa. Glob Health Action 2013; 6:19518. [PMID: 23364088 PMCID: PMC3556717 DOI: 10.3402/gha.v6i0.19518] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2012] [Revised: 10/25/2012] [Accepted: 10/25/2012] [Indexed: 11/14/2022] Open
Abstract
Context In the South African mining sector, cardiorespiratory-specific autopsies are conducted under the Occupational Diseases in Mines and Works Act (ODMWA) on deceased mineworkers to determine eligibility for compensation. However, low levels of autopsy utilisation undermine the value of the service. Objective To explore enablers and barriers to consent that impact on ODMWA autopsy utilisation for posthumous monetary compensation. Methods In-depth interviews were conducted with mineworkers, widows and relatives of deceased mineworkers as well as traditional healers and mine occupational health practitioners. Results A range of socio-cultural barriers to consent for an autopsy was identified. These barriers were largely related to gendered power relations, traditional and religious beliefs, and communication and trust. Understanding these barriers presents opportunities to intervene so as to increase autopsy utilisation. Conclusions Effective interventions could include engagement with healthy mine-workers and their families and re-evaluating the permanent removal of organs. The study adds to our understanding of utilisation of the autopsy services.
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Horey D, Flenady V, Heazell AEP, Khong TY. Interventions for supporting parents’ decisions about autopsy after stillbirth. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2012. [DOI: 10.1002/14651858.cd009932] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Breeze ACG, Statham H, Hackett GA, Jessop FA, Lees CC. Perinatal postmortems: what is important to parents and how do they decide? Birth 2012; 39:57-64. [PMID: 22369606 DOI: 10.1111/j.1523-536x.2011.00513.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Falling consent rates for postmortems, regardless of age of death, have been widely reported in recent years. The aim of this study was to explore parental attitudes to, and decision-making about, a perinatal postmortem after termination for fetal abnormality, late miscarriage, or stillbirth. METHODS A prospective self-completion questionnaire was given to 35 women and their partners. The participants had experienced second or third trimester pregnancy loss in a single fetal medicine and delivery unit in the United Kingdom and were making decisions about having a postmortem. They were asked to complete a questionnaire about their attitudes to, and expectations of, a perinatal postmortem. RESULTS Thirty-one questionnaires were received from parents of 17 babies (49% of those asked; 16 from mothers, 15 from fathers). Parents of nine babies (53%) said they would agree to a full postmortem, of three babies to a limited postmortem, and of four babies to an external examination only; one couple were undecided. The most important issues for the parents in this study that related to their decisions about a postmortem centered on the need for information, both for future planning and about what had happened. Moderately important issues related to altruism, which is, improving medical knowledge and helping other parents experiencing similar bereavement. Among the lowest scoring issues were potential barriers, such as concerns about cultural or religious acceptability of a postmortem, funeral delays, and what would happen to the baby's body. CONCLUSIONS Bereaved parents who participated in this study, where postmortem consent rates were relatively high, thought that their need for knowledge eclipsed assumed barriers when deciding whether or not to have a postmortem for their baby.
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Affiliation(s)
- Andrew C G Breeze
- Centre for Family Research, University of Cambridge, Free School Lane, Cambridge CB2 3RF, UK
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Flenady V, Middleton P, Smith GC, Duke W, Erwich JJ, Khong TY, Neilson J, Ezzati M, Koopmans L, Ellwood D, Fretts R, Frøen JF. Stillbirths: the way forward in high-income countries. Lancet 2011; 377:1703-17. [PMID: 21496907 DOI: 10.1016/s0140-6736(11)60064-0] [Citation(s) in RCA: 319] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Stillbirth rates in high-income countries declined dramatically from about 1940, but this decline has slowed or stalled over recent times. The present variation in stillbirth rates across and within high-income countries indicates that further reduction in stillbirth is possible. Large disparities (linked to disadvantage such as poverty) in stillbirth rates need to be addressed by providing more educational opportunities and improving living conditions for women. Placental pathologies and infection associated with preterm birth are linked to a substantial proportion of stillbirths. The proportion of unexplained stillbirths associated with under investigation continues to impede efforts in stillbirth prevention. Overweight, obesity, and smoking are important modifiable risk factors for stillbirth, and advanced maternal age is also an increasingly prevalent risk factor. Intensified efforts are needed to ameliorate the effects of these factors on stillbirth rates. Culturally appropriate preconception care and quality antenatal care that is accessible to all women has the potential to reduce stillbirth rates in high-income countries. Implementation of national perinatal mortality audit programmes aimed at improving the quality of care could substantially reduce stillbirths. Better data on numbers and causes of stillbirth are needed, and international consensus on definition and classification related to stillbirth is a priority. All parents should be offered a thorough investigation including a high-quality autopsy and placental histopathology. Parent organisations are powerful change agents and could have an important role in raising awareness to prevent stillbirth. Future research must focus on screening and interventions to reduce antepartum stillbirth as a result of placental dysfunction. Identification of ways to reduce maternal overweight and obesity is a high priority for high-income countries.
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Affiliation(s)
- Vicki Flenady
- Mater Medical Research Institute, South Brisbane, QLD, Australia.
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Breeze ACG, Jessop FA, Set PAK, Whitehead AL, Cross JJ, Lomas DJ, Hackett GA, Joubert I, Lees CC. Minimally-invasive fetal autopsy using magnetic resonance imaging and percutaneous organ biopsies: clinical value and comparison to conventional autopsy. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2011; 37:317-323. [PMID: 20878677 DOI: 10.1002/uog.8844] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVES Autopsy is an important investigation following fetal death or termination for fetal abnormality. Postmortem magnetic resonance imaging (MRI) can provide macroscopic information of comparable quality to that of conventional autopsy in the event of perinatal death. It does not provide tissue for histological examination, which may limit the quality of counseling for recurrence risks and elucidation of the cause of death. We sought to examine the comparability and clinical value of a combination of postmortem MRI and percutaneous fetal organ biopsies (minimally invasive autopsy (MIA)) with conventional fetal autopsy. METHODS Forty-four fetuses underwent postmortem MRI and attempted percutaneous biopsy (using surface landmarks) of major fetal organs (liver, lung, heart, spleen, kidney, adrenal and thymus) following fetal death or termination for abnormality, prior to conventional autopsy, which was considered the 'gold standard'. We compared significant findings of the two examinations for both diagnostic information and clinical significance. Ancillary investigations (such as radiographs and placental histology) were regarded as common to the two forms of autopsy. RESULTS In 21 cases conventional autopsy provided superior diagnostic information to that of MIA. In two cases the MIA provided superior diagnostic information to that of conventional autopsy, when autolysis prevented detailed examination of the fetal brain. In the remaining 21 cases, conventional autopsy and MIA provided equivalent diagnostic information. With regard to clinical significance, however, in 32 (72.7%) cases, the MIA provided information of at least equivalent clinical significance to that of conventional autopsy. In no case did the addition of percutaneous biopsies reveal information of additional clinical significance. CONCLUSIONS Although in some cases MRI may provide additional information, conventional perinatal autopsy remains the gold standard for the investigation of fetal death. The utility of adding percutaneous organ biopsies, without imaging guidance, to an MRI-based fetal autopsy remains unproven. Postmortem MRI, combined with ancillary investigations such as placental histology, external examination by a pathologist, cytogenetics and plain radiography provided information of equivalent clinical significance in the majority of cases.
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Affiliation(s)
- A C G Breeze
- Division of Maternal-Fetal Medicine, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, UK
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Odendaal HJ, Elliott A, Kinney HC, Human M, Gaspar D, Petersen D, Randall B, Dempers J. Consent for autopsy research for unexpected death in early life. Obstet Gynecol 2011; 117:167-171. [PMID: 21173659 PMCID: PMC3268257 DOI: 10.1097/aog.0b013e318200cb17] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Research in sudden death in fetuses (stillbirth) and infants (sudden infant death syndrome [SIDS]) is urgently needed, particularly in high-risk populations involving socioeconomic disadvantaged families. Essential to such research is the analysis of fetal and infant tissues at autopsy. Obtaining consent for donating autopsy tissues for research is especially problematic in socioeconomically disadvantaged populations in which mistrust of the medical establishment often exists. In this article, we present communication strategies for obtaining consent for research in autopsy tissues of stillbirth and SIDS cases in socioeconomically disadvantaged populations. Recommendations are provided about preparation for and the timing, setting, and content of the consent interview. The same lines of open and transparent communication delineated in this article are applicable to obtaining consent for the autopsy and autopsy research. Although the grief responses to the untimely death of the fetus or infant are universal and the recommendations of this essay are widely applicable to the general population, the expression of this grief and feelings toward autopsy-based research in socioeconomically disadvantaged populations may raise special issues that health care workers should be aware of when obtaining consent for research on autopsy-derived tissues.
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Affiliation(s)
- Hein J Odendaal
- *For members of the PASS Network, see the Appendix online at http://links.lww.com/AOG/A212. From the Department of Obstetrics and Gynecology, Faculty of Health Science, Stellenbosch University, Tygerberg, South Africa; the Health Disparities Research Center, Sanford Research/University of South Dakota, Sioux Falls, South Dakota; the Department of Pathology, Children's Hospital Boston and Harvard Medical School, Boston, Massachusetts; the Department of Pathology, University of South Dakota School of Medicine, Sioux Falls, South Dakota; the Division of Forensic Medicine and Pathology, Department of Pathology and Western Cape Forensic Pathology Services, Health Science Faculty, Stellenbosch University, Cape Town, South Africa
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Costa S, Rodrigues M, Centeno MJ, Martins A, Vilan A, Brandão O, Guimarães H. Diagnosis and cause of death in a neonatal intensive care unit--how important is autopsy? J Matern Fetal Neonatal Med 2010; 24:760-3. [PMID: 20945996 DOI: 10.3109/14767058.2010.520047] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To characterize mortality in a tertiary referral Neonatal Intensive Care Unit (NICU) in Portugal and evaluate the concordance between ante-mortem and post-mortem diagnoses. METHODS Retrospective review of the clinical and pathological records of infants who died in five consecutive years was done. Pathological findings and clinical diagnoses were compared and classified according to general concordance and to modified Goldman classification. RESULTS During the referred period, 1938 patients were admitted to the NICU, with a mortality rate of 5.7% (110 patients). The median of age at death was 10.5 days and the most frequent causes of death were congenital malformations and prematurity with its complications. Autopsy was performed in 53 patients resulting in a 48.2% overall autopsy rate. There was complete agreement between pathological and clinical diagnoses in 18 cases (34%) and additional findings were identified in 22 cases; in 13 cases (24.5%), the diagnosis was revised or established by pathology. Five autopsies revealed information relevant for genetic counseling. CONCLUSION Despite the high agreement rate between clinical and pathological diagnoses, autopsy frequently added important data, including several cases in which it established the diagnosis or provided information relevant for parental counseling regarding future pregnancies.
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Affiliation(s)
- Sandra Costa
- Neonatal Intensive Care Unit, Hospital São João, Porto, Portugal.
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Abstract
Our objectives were to determine the perinatal autopsy rate in a tertiary hospital in Malaysia and to quantify the value of the perinatal autopsy. All stillbirths, miscarriages, therapeutic abortions, and neonatal deaths between January 1, 2004, and August 31, 2009, were identified from the archives. The autopsy findings were compared with the clinical diagnoses. The autopsy reports were also reviewed to determine if it would be possible to improve the quality of the autopsies. There were 807 perinatal deaths, of which 36 (4.5%) included an autopsy. There were ethnic differences in the rate of autopsy, with the lowest rate among the Malays. The autopsy provided the diagnosis, changed the clinical diagnosis, or revealed additional findings in 58.3% of cases. Ancillary testing, such as microbiology, chromosomal analysis, and biochemistry, could improve the quality of the autopsy. This study provides further data on the perinatal autopsy rate from an emerging and developing country. It reaffirms the value of the perinatal autopsy. Attempts must be made to improve on the low autopsy rate while recognizing that the performance of autopsies can be enhanced through the use of ancillary testing.
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Affiliation(s)
- Geok Chin Tan
- Department of Pathology, Universiti Kebangsaan Malaysia, Cheras, Malaysia.
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Racape J, De Spiegelaere M, Alexander S, Dramaix M, Buekens P, Haelterman E. High perinatal mortality rate among immigrants in Brussels. Eur J Public Health 2010; 20:536-42. [PMID: 20478837 DOI: 10.1093/eurpub/ckq060] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The relation between immigration status and perinatal mortality is unclear. The objective of this study is to describe and measure inequalities in perinatal mortality and causes of perinatal deaths according to maternal nationality and socioeconomic status. METHODS A population-based cohort study related to all babies born during the period of 1998-2006 whose mothers were living in Brussels, irrespective of the place of delivery. Perinatal and post-perinatal mortality were analysed according to the nationality and sociodemographic characteristics of the mothers at birth. We used logistic regression to estimate the odds ratios (ORs) for the association between mortality and nationality. RESULTS The women of sub-Saharan Africa experience a 50% excess in perinatal mortality, which primarily reflects a high rate of preterm deliveries and low birth weight, as well as a low socioeconomic level. Paradoxically, despite their favourable rates of preterm and low-birth-weight births, Maghrebian and Turkish women experience a strong excess (50-70%) of perinatal mortality caused primarily by congenital anomalies. Differences in age, parity distributions and multiple births play no significant role, and the excess does not reflect low socioeconomic levels. This excess of perinatal mortality contrasts with the absence of an excess of post-perinatal mortality. CONCLUSION In Brussels, patterns of inequalities in perinatal mortality and causes of perinatal deaths vary according to nationality; perinatal mortality is increased in particular ethnic groups independently of socioeconomic status and maternal characteristics.
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Affiliation(s)
- Judith Racape
- Département de Biostatistiques, School of Public Health, Université Libre de Bruxelles, Brussels, Belgium
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Angelini P, Hawkins C, Laperriere N, Bouffet E, Bartels U. Post mortem examinations in diffuse intrinsic pontine glioma: challenges and chances. J Neurooncol 2010; 101:75-81. [DOI: 10.1007/s11060-010-0224-7] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2010] [Accepted: 05/04/2010] [Indexed: 10/19/2022]
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Thayyil S, Chitty LS, Robertson NJ, Taylor AM, Sebire NJ. Minimally invasive fetal postmortem examination using magnetic resonance imaging and computerised tomography: current evidence and practical issues. Prenat Diagn 2010; 30:713-8. [DOI: 10.1002/pd.2534] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Legal, Social, and Ethical Issues. AUTOPSY PATHOLOGY 2009. [PMCID: PMC7161395 DOI: 10.1016/b978-1-4160-5453-5.00002-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Autopsies and improved perinatal mortality in Slovakia. Eur J Obstet Gynecol Reprod Biol 2008; 137:114-5. [DOI: 10.1016/j.ejogrb.2007.08.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2007] [Revised: 08/14/2007] [Accepted: 08/27/2007] [Indexed: 11/20/2022]
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