Parents should be offered the opportunity to discuss the possibility of having a PM examination, so that they can reach an informed decision. Foetal and perinatal PMs requires specialized skills that need to be integrated with the obstetric and neonatal history and with the results obtained from other disciplines, such as cytogenetics, molecular genetics, microbiology, clinical chemistry, and radiology. The traditional PM is still the gold standard but: are invasive, many parents find the concept upsetting for personal, religious or cultural reasons, accuracy like conventional autopsy for detection of cause of death or major abnormality has been shown with PMMRI.
Our service in Sheffield offers provision of MRI Autopsy set up in July 2012. Parents are first offered a full PM. If decline: PMMRI. Consent form tailored to options. We conduct PM MRI intrauterine foetal deaths (≥ 12 WGA), early and late neonatal deaths (up to 28 days) and termination of pregnancy.
Our experience is that we have a high level of identifying a Relevant Condition at Death.
PMMRI, together with ancillary investigations including microbiology and placental examination where appropriate, has very high agreement with a conventional invasive autopsy. But, conventional PMMRI is poor at detecting microscopic changes such as disseminated sepsis.
For very early gestations, Micro-CT is another potential alternative diagnostic modality for imaging small objects, using CT technology but at improved resolution down to micrometres rather than milli-meters, and has recently been used to show very high quality imaging with good diagnostic accuracy.
Due to the shortage of Paediatric and Perinatal Pathologists, the development of imaging technology and the genetic analysis, I perceive that the way forward will include that, consent permitting, the consultant will decide whether the investigation is suitable for a PM imaging (MRI/microCT) or if it requires an invasive postmortem.