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Re: Stillbirth collection by Man et al
Author(s) -
Cox P.,
Marton T.,
Hargitai B.,
Coetzee A.,
Bowen C.,
Penman D.,
Evans M.,
Gan C.,
French P.,
Cohen M.,
Holden S.,
Allotey J.,
Evans C.,
Murphy A.,
Turner K.,
Cullinane C.,
Stahlschmidt J.,
Kokai G.,
Al Adnani M.,
Marnerides A.,
Vadgama B.,
McPartland J.
Publication year - 2017
Publication title -
ultrasound in obstetrics and gynecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.202
H-Index - 141
eISSN - 1469-0705
pISSN - 0960-7692
DOI - 10.1002/uog.17380
Subject(s) - autopsy , medicine , chorioamnionitis , context (archaeology) , cause of death , demise , fetal death , obstetrics , fetus , pregnancy , pediatrics , intensive care medicine , disease , pathology , law , paleontology , biology , political science , genetics
We read with great interest the recent series of papers by Man et al.1–5, on a range of aspects of autopsy following intrauterine fetal demise, based on a large cohort of cases. These papers are timely given the current drive to decrease stillbirth rates in the UK and highlight both the importance and limitations of autopsy and placental examination in this sad, and all-too-common, situation. We would like to highlight a few points in relation to these papers, which may help to inform the debate about the utility of autopsy. In the first paper1, examining the factors affecting the determination of cause of death at autopsy, we were concerned that ascending infection was accepted as a primary cause of death at all gestations, regardless of whether there was evidence of fetal infection. It is well known that chorioamnionitis is extremely common in unselected placentae from live infants and therefore, unless severe or accompanied by fetal infection or response, it may be an incidental finding. In addition, the paper considers together all secondand third-trimester losses, despite very different causes of death. We were pleased to read that the authors view the role of the autopsy as identifying the mechanism as well as the cause of death. Of note in this paper, they identified a high rate of ‘findings of uncertain significance’. It is important that such findings are documented, as they may be of value in the wider context of understanding the mechanism rather than the cause of death. This distinction is recognized in the ReCoDe classification of stillbirths, which seeks to identify Relevant Conditions at Death, rather than a single ‘cause of death’6. In a similar vein, in the paper addressing the use of routine histology at autopsy2 the authors show that histological examination rarely provides a primary cause of death in stillborn infants. This is at odds with previous publications7 and with our collective experience and, in addition, portrays a misunderstanding of the role of histology in the perinatal autopsy.