Fetal autopsy: a review of recent developments.
OBJECTIVE
To analyze recent changes in fetal autopsy in response to developments in prenatal medicine.


METHODS
During the period 1988 through 1997, 783 fetuses (75% induced abortions, 18% spontaneous abortions, and 7% stillbirths, all between the 12th and 40th week of gestation) with prenatally diagnosed congenital malformations and chromosomal aberrations were analyzed. We divided the autopsies into two periods: period A (1988-92, n=370) and period B (1993-97, n=413). All fetuses were analyzed before completion of 20 weeks of gestation. The malformations of the organ systems were presented according to their frequency for fetuses independent of the weeks of gestation.


RESULTS
An autopsy was performed prior to the completion of 20 weeks of gestation for 24% of the fetuses in period A and 45% in period B (P<0.0001). The number of diagnosed congenital heart malformations increased from 16% in period A to 23% in period B. The number of congenital heart malformations before completion of 20 weeks of gestation was only 21% in period A as compared to 42% in period B.


CONCLUSIONS
In period B, clinical questions were raised in a more concrete form and ultrasound images gave more detailed information than in period A. Access to prenatal findings prior to postmortem examination has helped investigators to develop a specific, clinically oriented, autopsy strategy based on the prenatal findings which makes it possible to diagnose very small malformations and to select sectional planes of special interest. The use of an interdisciplinary database is required for communication.
Tennstedt
C
C
Department of Pathology, Charité Medical Faculty of the Humboldt University, D 10098 Berlin, Germany. cornelia.tennstedt@charite.de
Hufnagl
P
P
Chaoui
R
R
Körner
H
H
Dietel
M
M
D000015:Abnormalities, Multiple / Q000453:epidemiology / Q000235:genetics / Q000473:pathology*; D000028:Abortion, Induced; D001344:Autopsy / Q000379:methods / Q000706:statistics & numerical data*; D002869:Chromosome Aberrations; D016208:Databases, Factual; D005260:Female; D005313:Fetal Death; D005858:Germany; D006330:Heart Defects, Congenital / Q000453:epidemiology / Q000473:pathology; D006801:Humans; D011247:Pregnancy