Internal Post-Mortem Assessment
Internal post-mortem examination is encouraged, but not required for WiSSP evaluation, and other parts of the evaluation may provide a diagnosis. Nonetheless, internal examination frequently provides information of a diagnostically critical nature. Indeed, in the WiSSP series of assessments, internal postmortem evaluation demonstrated one or more major abnormalities in 31% of all stillborns. And, in an unbiased subset of these, analysis suggests that not completing an internal postmortem evaluation would have resulted in about 20% of all diagnoses being missed. Most of the time, the critical diagnostic elements were identified by gross pathologic evaluation. It is, in fact, quite uncommon for histologic investigations to provide etiologically relevant information that would otherwise remain undiscovered.
A variety of resources are available to help guide the general pathologist in the postmortem investigation of a stillborn infant. A guideline for care has been developed by the College of American Pathologists that includes statements regarding the importance of autopsy following stillbirth. This may be of some utility in circumstances (e.g. managed care settings) where such an evaluation must be justified. The full text of this guideline can be found in:
Bove KE and the Autopsy Committee of the College of American Pathologists (1997): Practice Guidelines for Autopsy Pathology: The Perinatal and Pediatric Autopsy. Arch Pathol Lab Med 121:368-376.
More recently, the Stillbirth Collaborative Research Network has published a detailed postmortem protocol:
Pinar H, Koch MA, Hawkins H, Heim-Hall J, Abramowski CR, Thorsten VR, Carpenter MW, Zhou HH, Reddy UM and the Stillbirth Collaborative Research Network (2012): The stillbirth collaborative research network postmortem examination protocol. Am J Perinatol 29(3):187-202.
Various other protocols and reporting tools have been published. Secondary references that may be particularly helpful to the pathologist who is asked to complete autopsies on stillborn infants include:
Gilbert-Barness E (2 ed.): Potter's Pathology of the Fetus and Infant. St. Louis: Mosby-Year Book, 2007.
Wigglesworth JS: Perinatal Pathology, Second Edition. Philadelphia: W.B. Saunders, 1996.
Winter RM, Knowles SAS, Bieber FR, Baraitser M: The Malformed Fetus and Stillbirth - A Diagnostic Approach. New York: John Wiley & Sons, 1988.
Kalousek DK, Fitch N, Paradice BA: Pathology of the Human Embryo and Previable Fetus. New York: Springer-Verlag, 1990.