Less‐invasive autopsy for early pregnancy loss

Abstract

Autopsy investigations provide valuable information regarding fetal death that can assist in the parental bereavement process, and influence future pregnancies, but conventional autopsy is often declined by parents because of its invasive approach. This has led to the development of less‐invasive autopsy investigations based on imaging technology to provide a more accessible and acceptable choice for parents when investigating their loss. Whilst the development and use of more conventional clinical imaging techniques (radiographs, CT, MRI, US) are well described in the literature for fetuses over 20 weeks of gestational age, these investigations have limited diagnostic accuracy in imaging smaller fetuses. Techniques such as ultra‐high‐field MRI (>3T) and micro‐focus computed tomography have been shown to have higher diagnostic accuracy whilst still being acceptable to parents. By further developing and increasing the availability of these more innovative imaging techniques, parents will be provided with a greater choice of acceptable options to investigate their loss, which may in turn increase their uptake. We provide a narrative review focussing on the development of high‐resolution, non‐invasive imaging techniques to evaluate early gestational pregnancy loss.

In‐utero post‐mortem MRI, opportunistic imaging with diagnostic yield

“…� We illustrate the feasibility and potential diagnostic value of post-mortem intrauterine MRI Post-mortem MRI is an acceptable alternative to conventional autopsy for many families who refuse autopsy following stillbirth or miscarriage, as part of a minimally invasive autopsy. 1,2 Several studies comparing post-mortem MRI (PMMR) to antenatal in-utero MRI during life (iuMR) and ultrasound (US) have shown similar diagnostic accuracy. [3][4][5] Ideally, PMMR should be performed within 24 h of demise to minimize the deleterious effects of autolysis on image quality.…”

Minimally invasive autopsy – endoscopic approach to post-mortem diagnostics

“…The analysis of clinical data regarding the deceased improves the precision and correctness of the diagnosis made as a result of minimally invasive diagnostics [ 6 , 7 ]. Laparoscopic techniques were also used during autopsies for the diagnosis of foetuses, newborns, and paediatric patients [ 46 , 47 , 53 , 59 ]. Importantly, precise post-mortem foetal diagnostics provides key information for further medical care and genetic risk for couples planning further attempts to conceive a child [ 53 , 60 , 61 ].…”

Postmortem imaging of fetuses at early gestations: A comparison of microfocus computed tomography with postmortem magnetic resonance at 9.4 T and postmortem ultrasound

“…9,10 Nevertheless, direct head to head comparisons of these three imaging modalities (namely 9.4 T MRI, micro-CT and PMUS) have yet to be performed. 11…”