Routine perinatal and paediatric post-mortem radiography: detection rates and implications for practice

Abstract

Routine post-mortem paediatric radiography in foetuses and neonates is neither diagnostically useful nor cost-effective. A more evidence-based, selective protocol should yield significant cost savings.

Is there still a role for fetal and perinatal post-mortem radiography?

“…Arthurs et al identified 1027 cases in their institution of which 739 (72%) babygrams and 288 full skeletal surveys (28%) with an overall "abnormality" rate of 12.3% [31]. The abnormality rate was higher for skeletal surveys (18%) than babygrams (10%).…”

“…Based on these criteria, two recent studies in the UK and Netherlands have evaluated this issue in the light of modern antenatal US diagnostic techniques and modern day practices [31,32]. Arthurs et al identified 1027 cases in their institution of which 739 (72%) babygrams and 288 full skeletal surveys (28%) with an overall "abnormality" rate of 12.3% [31].…”

“…dysplasias or other skeletal abnormalities), but the routine cases were largely noncontributory. Only 2 cases (0.27% of 739) were identified which would have been "missed" if a policy of highly selective, rather than routine, fetal post-mortem radiography was employed [31].…”

“…As antenatal diagnostic ultrasound continues to improve [23], with a low incidence and prevalence of skeletal dysplasias and other fetal bony abnormalities, and most significant abnormalities now being identified antenatally (and typically the indication for termination of pregnancy), the yield of routine PMSS examinations to provide significant additional information in apparently anatomically normal fetuses and stillbirths is low. However, from the published literature, it is difficult to evaluate the additional value of PMSS over autopsy, or vice versa, partly because of methodological difficulties or selection criteria in the populations studied, although several studies have examined this issue since the 1970s [24][25][26][27][28][29][30][31].…”

The future of pediatric and perinatal postmortem imaging

“…Although the cost of performing an individual radiograph may also be relatively low, when used as a form of routine screening investigation this may not be cost-effective, especially in busy units performing several hundred investigations per year (2).As cross-sectional imaging studies have become a routine part of diagnostic clinical practice, these new imaging modalities are slowly being adopted into post-mortem investigations.…”