Ancillary and Advanced Techniques for the Postmortem Examination.

PURPOSE: This article describes how techniques such as advanced imaging, nucleic acid evaluation, integrated approaches, and data collection systems can facilitate the examination of a stillbirth or newborn, particularly when an autopsy is not possible.

CONTENT: The traditional autopsy remains the gold standard for investigating stillbirth and neonatal death. However, declining rates due to parental refusal, financial constraints, and cultural barriers highlight the need to widely adopt modern alternatives. This review examines emerging ancillary and advanced diagnostic techniques necessary to maximize diagnostic yield and ensure equitable access to comprehensive postmortem evaluations. Since imaging alone often misses critical microscopic pathologies, hybrid methods like Minimally Invasive Autopsy with Laparoscopically Assisted Sampling (MinImAL) are essential. MinImAL combines Postmortem Magnetic Resonance Imaging (PMMR) with image-guided tissue sampling to acquire specimens for histological and microbiological analysis. Complementary molecular techniques aid in identifying underlying genetic causes and informing recurrence risk. The success of these tests relies on optimized tissue selection. Systemic improvements include adopting standardized protocols, establishing Stillbirth Centers of Excellence, and using Artificial Intelligence (AI) for risk prediction. Importantly, integrating these advanced, less invasive methods is vital for addressing financial and racial health disparities, especially given the lack of Medicaid coverage for autopsy, thereby ensuring all bereaved families receive accurate and necessary diagnostic information.