Non-invasive perinatal postmortem examination

Aim To evaluate the efficiency of non-invasive perinatal postmortem examination as an alternative option in Middle East countries where full autopsy is denied. The study prospectively compared the results obtained by the non-invasive postmortem techniques with that obtained by full autopsy. Subjects and methods Initially, there was an extensive literature review of the available methods of non-invasive postmortem examination as well as the different causes of fetal and perinatal deaths. The usefulness of these ideas and points were evaluated for the possibility of using them in Middle East Region. Fifty five cases of perinatal and fetal deaths, including cases terminated because of congenital abnormalities, were studied. The efficiency of non¬invasive techniques was assessed: these included review of the clinical record, external examination, body weight and measurements, radiological examination, placenta, cord, and membranes examination, as well as microscopic examination (fine needle aspiration, needle biopsy). Results In 50 out of 55 (91%) cases, full autopsy did not alter the specific diagnosis made by the non-invasive techniques. In the remaining 5 cases, full autopsy did provide extra information by disclosing further internal malformations and lesions that might have affected genetic counselling. For non-invasive microscopic examination, needle biopsy was superior to fine needle aspiration, and its validity could have been increased by using ultrasound needle biopsy guidance. Although full autopsy remains the method of choice for evaluating fetal and perinatal deaths, particularly in malformed cases, non-invasive perinatal postmortem techniques are collectively an excellent option, particularly in Middle East societies where full autopsy is restricted. Conclusion In Middle East countries, basic steps need to be taken in order to establish and promote a standardised protocol for perinatal postmortem examination. This will facilitate the identification of different causes of fetal and perinatal deaths in this region, so that prevention and proper counselling can be provided for the family