English

Abstract

INTRODUCTION: Perinatal death rate is declining in developed and developing countries and so are perinatal autopsies. In the present days due to wider availability and awareness of prenatal scanning more and more congenital malformations are picked up in earlier weeks of gestation. This helps in counselling of the couple which usually leads to an informed decision on medical termination of pregnancy. Autopsy performed on such fetuses, yields additional information in many cases. AIMS: The study was carried out to determine how well the prenatal ultrasound findings correlate with autopsy findings and also to determine the cause of death where ultrasound was not performed in patients who had spontaneous intrauterine death and abortion. MATERIALS AND METHODS: This was a prospective study carried out over a period of two years in the department of pathology at Kamineni Academy of Medical Sciences and Research Centre, Hyderabad, from January 2013 to December 2014. A total of 23 fetal autopsies were performed of which one was a twin pregnancy. Brief maternal history, prenatal ultrasound scans, relevant biochemical markers and genetic studies wherever done, were noted. RESULTS: There were 14 male (60.86%) and 8 female (34.78%) fetuses, and in one case (4.34%) gender could not be identified. Nineteen cases (82.60 %) were less than 28 weeks of gestation. Medical termination of pregnancy was done in 13 cases (56.52 %) whereas, 10 patients (43.47 %) had spontaneous intrauterine death of the fetus. Ultrasound scanning was done in 15 cases (65.21 %). In 13 cases (86.66 %) the ultrasound and autopsy findings were correlating whereas in two cases (13.33 %) there were findings on imaging study which could not be identified on autopsy. Ultrasound was not done in 8 cases (34.78 %) out of which 5 cases (62.5 %) showed findings on autopsy which could have led to the fetal demise. Twelve cases (52.17 %) were referral cases which had come from other hospitals. Genetic studies were done in 6 cases (26.08 %) in the form of parental karyotyping and cord blood could be tested in only one case. CONCLUSIONS: There is a good correlation between prenatal ultrasound scanning and autopsy findings. However, functional heart defects, and minute ventricular septal defects cannot be identified on autopsy due to the small size of the organs. At the same time autopsy can demonstrate more accurately congenital malformations and unsuspected cord abnormalities. More awareness is required on the part of treating clinicians as to the appropriate sample collection, its timely transport to the laboratory in order to facilitate genetic testing.