American journal of obstetrics and gynecology · 2025
Clinical experience of a fetal postmortem imaging service using microfocus computed tomography.
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Simcock Ian C, Lamouroux Audrey, Shelmerdine Susan C, Sebire Neil J, Hutchinson John Ciaran, Arthurs Owen J
Аннотация
BACKGROUND: Postmortem imaging is becoming a more acceptable part of perinatal autopsy, particularly for early gestation or small fetuses in which conventional autopsies may be challenging and rejected by parents.
OBJECTIVE: This study aimed to establish the relative diagnostic yield of microfocus computed tomography as part of a less invasive autopsy in fetuses at <24 weeks of gestation.
STUDY DESIGN: This was a single-center, retrospective study of 7 years of 1007 consecutive unselected perinatal autopsies (2016-2023) of fetuses with a body weight of <300 g. Microfocus computed tomography was offered as an option to all referred fetuses with a body weight of <300 g. All parents gave fully informed written consent.
RESULTS: Of note, 1007 fetuses with a mean 17.9 weeks of gestation and a body weight of 92.4 g were imaged and categorized according to the mode of death. A diagnosis was made due to a range of examinations, including microfocus computed tomography, conventional autopsy, and external and placental examination in 515 of 1007 fetuses (51.1%), with a fetal cause in 212 of 1007 cases (21.1%; eg, cardiac septal abnormalities or neural tube defects), placental cause in 264 of 1007 cases (26.2%; eg, placental abruption or chorioamnionitis), or elements of both in 39 of 1007 cases (3.9%). The single most important diagnostic contributor was placental examination (353 cases [35.1%]). Microfocus computed tomography image quality enabled a diagnosis in 598 of 1007 cases (59.4%), higher in miscarriage (80.3%) and termination of pregnancy (74.9%) than in utero deaths (41.4%), in which maceration did not reduce the overall tissue state to nondiagnostic. The overall microfocus computed tomography abnormality detection rate, in which an abnormality was identified, was 31.0% (312/1007), the highest in the termination of pregnancy (80.7%) vs spontaneous miscarriage (17.9%). Only 43 fetuses required additional invasive autopsy (an autopsy "avoidance rate" of 95.7% [964/1007]). The median turnaround time was 18 days (interquartile range, 13-23).
CONCLUSION: The combination of routine external examination, placental assessment, and microfocus computed tomography postmortem imaging reached a diagnosis in >50% of early gestation fetuses, similar to historical cohorts. This was achieved within 3 weeks, with an autopsy avoidance rate of 96%, in line with parental consent.
OBJECTIVE: This study aimed to establish the relative diagnostic yield of microfocus computed tomography as part of a less invasive autopsy in fetuses at <24 weeks of gestation.
STUDY DESIGN: This was a single-center, retrospective study of 7 years of 1007 consecutive unselected perinatal autopsies (2016-2023) of fetuses with a body weight of <300 g. Microfocus computed tomography was offered as an option to all referred fetuses with a body weight of <300 g. All parents gave fully informed written consent.
RESULTS: Of note, 1007 fetuses with a mean 17.9 weeks of gestation and a body weight of 92.4 g were imaged and categorized according to the mode of death. A diagnosis was made due to a range of examinations, including microfocus computed tomography, conventional autopsy, and external and placental examination in 515 of 1007 fetuses (51.1%), with a fetal cause in 212 of 1007 cases (21.1%; eg, cardiac septal abnormalities or neural tube defects), placental cause in 264 of 1007 cases (26.2%; eg, placental abruption or chorioamnionitis), or elements of both in 39 of 1007 cases (3.9%). The single most important diagnostic contributor was placental examination (353 cases [35.1%]). Microfocus computed tomography image quality enabled a diagnosis in 598 of 1007 cases (59.4%), higher in miscarriage (80.3%) and termination of pregnancy (74.9%) than in utero deaths (41.4%), in which maceration did not reduce the overall tissue state to nondiagnostic. The overall microfocus computed tomography abnormality detection rate, in which an abnormality was identified, was 31.0% (312/1007), the highest in the termination of pregnancy (80.7%) vs spontaneous miscarriage (17.9%). Only 43 fetuses required additional invasive autopsy (an autopsy "avoidance rate" of 95.7% [964/1007]). The median turnaround time was 18 days (interquartile range, 13-23).
CONCLUSION: The combination of routine external examination, placental assessment, and microfocus computed tomography postmortem imaging reached a diagnosis in >50% of early gestation fetuses, similar to historical cohorts. This was achieved within 3 weeks, with an autopsy avoidance rate of 96%, in line with parental consent.