Value and quality of perinatal and infant postmortem examinations: cohort analysis of 400 consecutive deaths.
OBJECTIVE
To evaluate the contribution that perinatal and infant necropsy makes to clinical practice and to see how this might be influenced by the quality of the investigation.


METHODS
Cohort analysis, with data from the all Wales perinatal survey, of perinatal and infant deaths during 1993 of babies born to mothers usually resident in Wales. The clinicopathological classification of death based on clinical details was compared with the classification after necropsy. Similarly, cases in which necropsy yielded new information were identified. The quality of the necropsy was assessed by scoring six aspects of the examination.


METHODS
400 consecutive deaths at 20 weeks of gestation to 1 year of age.


METHODS
Necropsy rate, effect of necropsy on clinicopathological classification, new information disclosed by necropsy, quality of necropsies, and the link between new information and quality of the necropsy.


RESULTS
Necropsy was performed in 232 cases (58%). The clinicopathological classification was altered by necropsy in 29 cases (13%). New information was obtained in 60 cases (26%), and in 42 (18%) it disclosed the cause of death. The quality of necropsy was substantially higher when the main cause of death was detected than when nothing new was found.


CONCLUSIONS
Necropsy is underused. Clinicians should be more positive about necropsies and realise how much clinically relevant information can be obtained from a good quality examination.
University of Wales College of Medicine, Cardiff.
P H
PH
Cartlidge
A T
AT
Dawson
J H
JH
Stewart
G M
GM
Vujanic
D001344:Autopsy / Q000592:standards* / Q000706:statistics & numerical data; D002423:Cause of Death; D015331:Cohort Studies; D000013:Congenital Abnormalities / Q000473:pathology; D005069:Evaluation Studies as Topic; D005313:Fetal Death / Q000473:pathology; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D010338:Pathology, Clinical; D011787:Quality of Health Care; D014852:Wales