Diagnostic accuracy of perinatal post-mortem ultrasound (PMUS): a systematic review

Abstract

ObjectiveUltrasound is ubiquitous in live paediatric imaging; however, its usage in post-mortem setting is less established. This systematic review aims to evaluate the diagnostic accuracy of paediatric post-mortem ultrasound (PMUS).DesignMEDLINE, Embase and Cochrane Library databases were queried for studies published between 1998 and 2018 assessing PMUS diagnostic accuracy rates in children<18 years old, using autopsy as reference standard. Risk of bias was assessed using Quality Assessment of Diagnostic Accuracy Studies 2. A bivariate random-effects model was used to obtain combined mean estimates of sensitivity and specificity for different body systems.ResultsFour studies were included, all relating to ultrasound for perinatal deaths. The mean diagnostic sensitivity and specificity for neurological abnormalities were 84.3% (95% CI: 70.8% to 92.2%) and 96.7% (95% CI: 86.5% to 99.3%); for cardiothoracic abnormalities 52.1% (95% CI: 27.6% to 75.5%,) and 96.6% (95% CI: 86.8% to 99.2%); and for abdominal abnormalities 78.4% (95% CI: 61.0% to 89.4%) and 97.3% (95% CI: 88.9% to 99.4%). Combining all body systems, the mean sensitivity and specificity were 73.3% (95% CI: 59.9% to 83.5%) and 96.6% (95% CI: 92.6% to 98.4%).ConclusionsPMUS demonstrates a reasonable diagnostic accuracy, particularly for abdominal and neurological abnormalities, although cardiac anomalies were less readily identified.Trial registration numberCRD42018106968.

Are non-invasive or minimally invasive autopsy techniques for detecting cause of death in prenates, neonates and infants accurate? A systematic review of diagnostic test accuracy

“…To date, seven systematic reviews have attempted to address the evidence. [25][26][27][28][29][30][31] However, it is clear that there are major limitations to the search methodologies in these reviews, potentially introducing bias, which means that the results cannot be interpreted with confidence. With the exception of the review by Wojcieszek et al, these reviews all focus on imaging techniques and do not consider other viable non-invasive or minimally invasive techniques.…”

“…With the exception of the review by Wojcieszek et al, these reviews all focus on imaging techniques and do not consider other viable non-invasive or minimally invasive techniques. [25][26][27][28][29][30][31] Similarly, the population groups are highly variable. Some consider a whole of life population, while others consider few very distinct perinatal populations.…”

Less‐invasive autopsy for early pregnancy loss

“…73 It may also be better understood by parents when consenting for post-mortem imaging having already undergone ante-natal ultrasound scanning and is also unaffected by tissue fixation. 61,72,[74][75][76][77] PMUS also has the advantage of being able to direct needle biopsies for tissue sampling. 47,73,[78][79][80][81] However, PMUS is operatordependent, requiring specialist training to develop the skills and experience to accurately identify possible causes of pregnancy loss in these smaller fetuses.…”

“…61 Although relatively high sensitivities and specificities have been reported from multiple studies (ranging from 73% to 97%, similar to 1.5T PMMR), most studies have found lower diagnostic rates and higher yield of non-diagnostic imaging in fetuses below 20 weeks gestation. 51,61,72,75,76…”

A pragmatic evidence-based approach to post-mortem perinatal imaging

“…When the imaging is of diagnostic quality, ultrasound has been reported to have a similar accuracy to both 1.5 T [ 25 ] and 3 T MRI [ 26 ], with an estimated overall sensitivity of 73% and specificity 97% (based on a systematic review of 455 perinatal losses)[ 27 ]. The highest sensitivity rates were found for brain imaging (84%) and lowest for cardiothoracic abnormalities (51%).…”