Routine perinatal post mortem radiography: current practice and future implications

Abstract

Purpose Skeletal radiography is routinely performed following foetal death or still birth, to diagnose rare skeletal dysplasias and detect unsuspected bone abnormalities. However, as most significant abnormalities are now detected antenatally, the additional yield of radiography is likely to be low. In this study we reviewed our practice of PM skeletal radiography to assess its current yield and cost effectiveness. Methods We retrospectively evaluated all perinatal post mortem radiography (AP & lateral babygrams) performed over a 2.5 year period (2010–2012) at our institution. We compared the antenatal history with paediatric radiology reports and the post mortem findings. Results Only 74/739 cases (10%) performed over this period were abnormal. Of these 74, 41 were clinically indicated, and 36/41 (87%) were diagnostic or contributed new findings. Of 33 cases not clinically indicated, only 2 radiographs yielded unexpected findings (2/33=6%). Overall, 705/739 cases (95.4%) were normal or non-contributory. Conclusions Our study confirms a low yield of post mortem radiography. By stopping routine radiography, only 2/739 (0.2%) of cases would have been missed but this would represent a 90% cost saving on current practice. At our institution, we propose replacing routine perinatal post mortem radiography by selected post mortem CT in suspected abnormalities, to test whether this increases the diagnostic yield.