1
|
Sreenivas A, Jaihind Jothikaran TA, Lewis L, Mathew M. Community perceptions of postmortem examination and minimally invasive tissue sampling in neonates:a qualitative study in South India. BMC Pregnancy Childbirth 2023; 23:804. [PMID: 37990299 PMCID: PMC10664656 DOI: 10.1186/s12884-023-06123-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 11/11/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND Postmortem examination is the gold standard for establishing the cause of death. Minimally Invasive Tissue Sampling (MITS) of organs is a novel approach that can be used as an alternative to postmortem examination. In this study, the community perceptions in two states in South India towards neonatal postmortem and the acceptance towards the MITS technique is studied. METHODS In-depth interviews were conducted among the participants from Kerala and Karnataka to understand the perception towards postmortem and the acceptance of the novel MITS technique. The interviews were audio recorded, and a thematic analysis was done to identify the overarching themes and codes. RESULTS The knowledge and attitude of participants on conventional and MITS postmortem techniques, reasons for refusal, and the need for raising awareness were identified in the study. Participants favored the MITS techniques as it was less disfiguring and less time-consuming. The major concerns for refusal of conventional postmortem were that the procedure was disfiguring, time-consuming, and caused emotional stress to the parents. CONCLUSIONS Participants favored the MITS approach over conventional postmortem as it caused less disfigurement and was conducive to the religious practice of burial of the body.
Collapse
Affiliation(s)
- Athira Sreenivas
- Department of Pathology, Centre for Foetal and Perinatal Pathology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Teddy Andrews Jaihind Jothikaran
- Department of Social and Health Innovation, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Leslie Lewis
- Department of Pediatrics, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Mary Mathew
- Department of Pathology, Centre for Foetal and Perinatal Pathology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India.
| |
Collapse
|
2
|
Riches NO, Workalemahu T, Johnson EP, Silver RM, Lopez S, Page J, Sartori B, Rothwell E. Creating a postmortem examination decision aid: Suggestions from bereaved parents of a stillborn. PATIENT EDUCATION AND COUNSELING 2023; 112:107746. [PMID: 37060683 PMCID: PMC10184762 DOI: 10.1016/j.pec.2023.107746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 03/27/2023] [Accepted: 04/10/2023] [Indexed: 05/09/2023]
Abstract
OBJECTIVES To understand the postmortem decision-making needs and preferences of parents of a stillborn. METHODS A qualitative content analysis was conducted. Patients who received stillbirth care at the University of Utah in the last 5 years, were 18 years of age or older, and English speakers, were invited to participate via an email and follow-up phone call. Participants were interviewed about their experiences, values, beliefs, decision-making experience regarding the postmortem examinations of their stillborn, and suggestions for how to assist their decision-making needs. RESULTS Nineteen participants who consented to one or more postmortem examination of their stillborn were interviewed. They expressed needing information, altruism, and/or a belief in science as reasons for consenting. The most common reason for declining was already knowing the stillbirth cause. Recommendations for a decision aid included a description of all stillbirth evaluation options, risks and benefits, and a timeline. CONCLUSION Participants had a variety of reasons for consenting to or declining postmortem examinations of their stillborn. Recommendations for a decision aid include a full description of each examination, the risks and benefits, and a timeline. PRACTICAL IMPLICATIONS An example decision aid was created from recommendations, which presents balanced information to help support couple's decision-making.
Collapse
Affiliation(s)
- Naomi O Riches
- Department of Obstetrics and Gynecology, University of Utah School of Medicine, 30N 1900 E, Suite 2B200, Salt Lake City, UT 84132, USA.
| | - Tsegaselassie Workalemahu
- Department of Obstetrics and Gynecology, University of Utah School of Medicine, 30N 1900 E, Suite 2B200, Salt Lake City, UT 84132, USA
| | - Erin P Johnson
- Department of Obstetrics and Gynecology, University of Utah School of Medicine, 30N 1900 E, Suite 2B200, Salt Lake City, UT 84132, USA
| | - Robert M Silver
- Department of Obstetrics and Gynecology, University of Utah School of Medicine, 30N 1900 E, Suite 2B200, Salt Lake City, UT 84132, USA
| | - Sarah Lopez
- Department of Obstetrics and Gynecology, University of Utah School of Medicine, 30N 1900 E, Suite 2B200, Salt Lake City, UT 84132, USA
| | - Jessica Page
- Department of Obstetrics and Gynecology, University of Utah School of Medicine, 30N 1900 E, Suite 2B200, Salt Lake City, UT 84132, USA; Department of Maternal Fetal Medicine, Intermountain Healthcare, 5063 S. Cottonwood St Ste 100, Murray, UT 84157, USA
| | - Brittney Sartori
- University of Utah College of Nursing, 10 2000 E., Salt Lake City, UT 84112, USA
| | - Erin Rothwell
- Department of Obstetrics and Gynecology, University of Utah School of Medicine, 30N 1900 E, Suite 2B200, Salt Lake City, UT 84132, USA; University of Utah Interim Vice President for Research, 201 Presidents Circle, Rm 210, Salt Lake City, UT 84112, USA
| |
Collapse
|
3
|
Groenendaal F, Nikkels PGJ. Autopsy in a neonatal intensive care unit: do we still need it in 2022? J Pediatr (Rio J) 2022; 98:442-443. [PMID: 35609639 PMCID: PMC9510792 DOI: 10.1016/j.jped.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 05/06/2022] [Indexed: 12/02/2022] Open
Affiliation(s)
- Floris Groenendaal
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands.
| | - Peter G J Nikkels
- Department of Pathology, Wilhelmina Children's Hospital, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands
| |
Collapse
|
4
|
Lockton J, Oxlad M, Due C. Grandfathers' Experiences of Grief and Support Following Pregnancy Loss or Neonatal Death of a Grandchild. QUALITATIVE HEALTH RESEARCH 2021; 31:2715-2729. [PMID: 34772285 DOI: 10.1177/10497323211041331] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Pregnancy loss and neonatal death are recognized as distressing experiences for parents and other family members. However, no research has specifically addressed the experiences of grandfathers. This study aimed to understand grandfathers' grief experiences, and to identify supports they provide, receive, and desire following the loss of a grandchild in pregnancy or the neonatal period. Semi-structured interviews with 10 Australian grandfathers were analyzed, applying principles of thematic analysis. Three themes related to grief and three themes related to support were identified. Findings indicated that grandfathers expressed grief in a range of ways, and emotional expressiveness did not reflect the extent of their grief. Grandfathers typically provided extensive support to their child and family; however, few supports were available to help grandfathers. Recognition and validation of grandfathers' grief, early access to information, and guidance to a variety of supports including written materials, peer and professional support, is required.
Collapse
Affiliation(s)
- Jane Lockton
- The University of Adelaide, Adelaide, South Australia, Australia
| | - Melissa Oxlad
- The University of Adelaide, Adelaide, South Australia, Australia
| | - Clemence Due
- The University of Adelaide, Adelaide, South Australia, Australia
| |
Collapse
|
5
|
Struksnæs C, Blaas HGK, Eik-Nes SH, Tegnander E, Vogt C. Postmortem Assessment of Isolated Congenital Heart Defects Remains Essential Following Termination of Pregnancy. Pediatr Dev Pathol 2021; 24:422-429. [PMID: 33993792 DOI: 10.1177/10935266211016184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVES To investigate the correlation between prenatal ultrasound (US) and autopsy findings in pregnancies terminated due to isolated congenital heart defects (CHDs), including CHDs associated with heterotaxy syndrome. MATERIALS AND METHODS The material consists of 67 fetuses with prenatally detected isolated CHDs or CHDs associated with heterotaxy syndrome at a tertiary center in Norway between 1985 and 2014. The main CHDs were categorized into subdiagnoses of CHDs in accordance with ICD-10. The US and autopsy findings were categorized according to degree of concordance. RESULTS Gestational age at termination was 12 + 0-22 + 6 weeks. Hypoplastic left heart syndrome was the most common main diagnosis among the 67 fetuses (32.8%). There was full agreement between US and autopsy findings in 97.4% (222/228) of all subdiagnoses. The discrepant findings in three fetuses had no influence on the decision to terminate the pregnancy. CONCLUSIONS The correlation was high between prenatal US and postmortem findings in fetuses with isolated CHDs. Meticulous assessment of cardiac anatomy is particularly necessary when the decision to terminate relies on isolated CHDs. The trend of earlier termination challenges verification of diagnoses at autopsy. Consequently, the fetus should be examined at a tertiary center with fetal medicine specialists, pediatric cardiologists and perinatal pathologists.
Collapse
Affiliation(s)
- Camilla Struksnæs
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Harm-Gerd K Blaas
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.,National Center for Fetal Medicine, Department of Obstetrics and Gynecology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Sturla H Eik-Nes
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.,National Center for Fetal Medicine, Department of Obstetrics and Gynecology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Eva Tegnander
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.,National Center for Fetal Medicine, Department of Obstetrics and Gynecology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Christina Vogt
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Pathology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| |
Collapse
|
6
|
Nuzum D, Fitzgerald B, Evans MJ, O'Donoghue K. Maternity Healthcare Chaplains and Perinatal Post-Mortem Support and Understanding in the United Kingdom and Ireland: An Exploratory Study. JOURNAL OF RELIGION AND HEALTH 2021; 60:1924-1936. [PMID: 33415602 DOI: 10.1007/s10943-020-01176-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/26/2020] [Indexed: 06/12/2023]
Abstract
Perinatal autopsy rates have declined significantly in recent decades. There is a lack of consensus concerning the potential religious influences for bereaved parents in their decision making process for post-mortem. This online study of British and Irish maternity healthcare chaplains explored their understanding of general and local perinatal post-mortem procedures and their experiences in the support of parents. Participants included Christian, Muslim and non-faith chaplains. No chaplain identified any religious prohibition to perinatal post-mortem. A majority of chaplains reported that they had been asked about post-mortem by parents; only a minority felt adequately prepared. A key recommendation is that following appropriate training chaplains may be well placed to support colleagues and parents during the decision making process.
Collapse
Affiliation(s)
- D Nuzum
- Department of Obstetrics and Gynaecology, University College Cork, Cork University Maternity Hospital, Wilton, Cork, Ireland.
| | - B Fitzgerald
- Department of Histopathology, Cork University Hospital, Wilton, Cork, Ireland
| | - M J Evans
- Department of Pathology, Edinburgh Royal Infirmary, Edinburgh, Scotland
- Honorary Professor, Department of Molecular, Genetic and Population Health Studies, University of Edinburgh, Edinburgh, Scotland
| | - K O'Donoghue
- Department of Obstetrics and Gynaecology, University College Cork, Cork University Maternity Hospital, Wilton, Cork, Ireland
- Irish Centre for Maternal and Child Health Research (INFANT), University College Cork, Cork, Ireland
| |
Collapse
|
7
|
Abstract
PURPOSE OF REVIEW Uptake of perinatal autopsy has declined in the West over the past 30 years, largely because of reduced parental acceptance of a traditional invasive autopsy. Several studies have recently investigated the decline to identify the key factors and how they may be mitigated. RECENT FINDINGS Three main themes were identified that have been found to improve uptake of perinatal autopsy: improved communication, in particular ensuring the consent process was conducted as a conversation with time spent talking through the procedure and allowing time for questions; health professional training to ensure staff discussing autopsy with parents have adequate understanding of the procedure and are able to convey confidence and empathy; and availability of less invasive autopsy, including noninvasive as well as minimally invasive options. These should be offered alongside standard autopsy, which some parents may still prefer. SUMMARY This review highlights that the discussions that take place, and the options that are available to parents, can profoundly impact whether or not they consent to autopsy investigation. Further research should focus on the impact of offering less invasive options as well as evaluating the training and support materials that have recently been developed.
Collapse
Affiliation(s)
- Celine Lewis
- Population, Policy and Practice, UCL Great Ormond Street Institute of Child Health
- North Thames Genomic Laboratory Hub, Great Ormond Street NHS Foundation Trust
| | - Ian C Simcock
- Department of Clinical Radiology, Great Ormond Street Hospital for Children
- UCL Great Ormond Street Institute of Child Health
- National Institute for Health Research Biomedical Research Centre, Great Ormond Street Hospital, London, United Kingdom
| | - Owen J Arthurs
- Department of Clinical Radiology, Great Ormond Street Hospital for Children
- UCL Great Ormond Street Institute of Child Health
- National Institute for Health Research Biomedical Research Centre, Great Ormond Street Hospital, London, United Kingdom
| |
Collapse
|
8
|
Paganelli CR, Goco NJ, McClure EM, Banke KK, Blau DM, Breiman RF, Menéndez C, Rakislova N, Bassat Q. The evolution of minimally invasive tissue sampling in postmortem examination: a narrative review. Glob Health Action 2021; 13:1792682. [PMID: 32713325 PMCID: PMC7480574 DOI: 10.1080/16549716.2020.1792682] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Because of low acceptance rates and limited capacity, complete diagnostic autopsies (CDAs) are seldom conducted in low- and middle-income countries (LMICs). There have been growing investments in less-invasive postmortem examination methodologies, including needle-based autopsy, known as minimally invasive autopsy or minimally invasive tissue sampling (MITS). MITS has been shown to be a feasible and informative alternative to CDA for cause of death investigation and mortality surveillance purposes. OBJECTIVE The aim of this narrative review is to describe historical use and evolution of needle-based postmortem procedures as a tool to ascertain the cause of death, especially in LMICs. METHODS Key word searches were conducted in PubMed and EBSCO in 2018 and 2019. Abstracts were reviewed against inclusion and exclusion criteria. Full publications were reviewed for those abstracts meeting inclusion criteria and a start set was established. A snowball search methodology was used and references for all publications meeting inclusion criteria were manually reviewed until saturation was reached. RESULTS A total of 1,177 publications were initially screened. Following an iterative review of references, 79 publications were included in this review. Twenty-nine studies, published between 1955 and 2019, included MITS as part of postmortem examination. Of the publications included, 76% (60/79) have publication dates after 2010. More than 60% of all publications included addressed MITS in LMICs, and a total of nine publications compared MITS with CDA. CONCLUSIONS Although there is evidence of less-invasive postmortem sampling starting in the 1800s, more structured needle-based postmortem examination publications started to appear in the mid-twentieth century. Early studies were mostly conducted in high-income countries but starting in 2010 the number of publications began to increase, and a growing number of studies were conducted in LMICs. Initial studies in LMICs were disease-specific but since 2015 have evolved to include more expansive postmortem examination.
Collapse
Affiliation(s)
| | | | | | - Kathryn K Banke
- Centers for Disease Control and Prevention , Atlanta, GA, USA
| | - Dianna M Blau
- Centers for Disease Control and Prevention , Atlanta, GA, USA
| | - Robert F Breiman
- Department of Global Health, Rollins School of Public Health, Emory University , Atlanta, GA, USA
| | - Clara Menéndez
- ISGlobal Barcelona Institute for Global Health, Hospital Clínic - Universitat de Barcelona , Barcelona, Spain
| | - Natalia Rakislova
- ISGlobal Department of Pathology Barcelona Institute for Global Health, Hospital Clínic - Universitat de Barcelona , Barcelona, Spain
| | - Quique Bassat
- ISGlobal Barcelona Institute for Global Health, Hospital Clínic - Universitat de Barcelona , Barcelona, Spain
| |
Collapse
|
9
|
Reed K, Ferazzoli MT, Whitby E. "Why didn't we do it"? Reproductive loss and the problem of post-mortem consent. Soc Sci Med 2021; 276:113835. [PMID: 33780832 DOI: 10.1016/j.socscimed.2021.113835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 02/09/2021] [Accepted: 03/09/2021] [Indexed: 11/29/2022]
Abstract
Informed consent has been a much debated topic within the social sciences. It often forms a central feature of discussions on research in medical settings and in social research methods more broadly. While sympathetic to its' underlying principles of autonomy and choice, social scientists have tended to argue that these are seldom enacted in research or clinical practice. Rather, such principles are often circumscribed by wider social structures and by a culture of medical dominance. Drawing on data from a qualitative study on perinatal post-mortem, this paper explores informed consent in the emotionally charged clinical arena of perinatal pathology. Our in-depth analysis will provide fresh insight into post-mortem decision-making in the sensitive arena of baby loss. Our findings show how parents often found it difficult to give consent for post-mortem, and also for professionals to take consent from parents. It was also not uncommon for parents to experience regret over non-consent later on. One of our key findings, however, related to the sense of emotional and diagnostic closure often afforded by post-mortem when consent had been given. We conclude by arguing that, although we cannot resolve the tension between the principles of consent and their enactment in practice, we can develop a reflexive approach with which to navigate the process. In doing so, the paper contributes to wider sociological discussions on the meaning and use of informed consent in various settings beyond medical contexts.
Collapse
Affiliation(s)
- Kate Reed
- Department of Sociological Studies, University of Sheffield, Elmfield Building, Northumberland Road, Sheffield, S10 2TU, UK.
| | - Maria Teresa Ferazzoli
- University of Sheffield, Department of Sociological Studies, Elmfield, Northumberland Road, Sheffield, S10 2TU, UK.
| | - Elspeth Whitby
- Clinical Senior Lecturer/Honorary Consultant, University of Sheffield, Department of Oncology and Metabolism, Jessop Wing, Tree Root Walk, Sheffield, S10 2SF, UK.
| |
Collapse
|
10
|
Lewis C, Hutchinson JC, Riddington M, Hill M, Arthurs OJ, Fisher J, Wade A, Doré CJ, Chitty LS, Sebire NJ. Minimally invasive autopsy for fetuses and children based on a combination of post-mortem MRI and endoscopic examination: a feasibility study. Health Technol Assess 2020; 23:1-104. [PMID: 31461397 DOI: 10.3310/hta23460] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Less invasive perinatal and paediatric autopsy methods, such as imaging alongside targeted endoscopy and organ biopsy, may address declining consent rates for traditional autopsy, but their acceptability and accuracy are not known. OBJECTIVES The aims of this study were to provide empirical data on the acceptability and likely uptake for different types of autopsy among key stakeholders (study 1); and to analyse existing autopsy data sources to provide estimates of the potential efficacy of less invasive autopsy (LIA) and its projected utility in clinical practice (study 2). REVIEW METHODS Study 1: this was a mixed-methods study. Parents were involved in research design and interpretation of findings. Substudy 1: a cross-sectional survey of 859 parents who had experienced miscarriage, termination of pregnancy for fetal anomaly, stillbirth, infant or child death, and interviews with 20 responders. Substudy 2: interviews with 25 health professionals and four coroners. Substudy 3: interviews with 16 religious leaders and eight focus groups, with 76 members of the Muslim and Jewish community. Study 2: a retrospective analysis of national data in addition to detailed information from an existing in-house autopsy database of > 5000 clinical cases that had undergone standard autopsy to determine the proportion of cases by clinical indication group for which tissue sampling of specific internal organs significantly contributed to the diagnosis. RESULTS Substudy 1: 91% of participants indicated that they would consent to some form of LIA, 54% would consent to standard autopsy, 74% to minimally invasive autopsy (MIA) and 77% to non-invasive autopsy (NIA). Substudy 2: participants viewed LIA as a positive development, but had concerns around the limitations of the technology and de-skilling the workforce. Cost implications, skills and training requirements were identified as implementation challenges. Substudy 3: religious leaders agreed that NIA was religiously permissible, but MIA was considered less acceptable. Community members indicated that they might consent to NIA if the body could be returned for burial within 24 hours. Study 2: in 5-10% of cases of sudden unexplained death in childhood and sudden unexplained death in infants, the final cause of death is determined by routine histological sampling of macroscopically normal organs, predominantly the heart and lungs, and in this group routine histological sampling therefore remains an important aspect of investigation. In contrast, routine histological examination of macroscopically normal organs rarely (< 0.5%) provides the cause of death in fetal cases, making LIA and NIA approaches potentially highly applicable. LIMITATIONS A key limitation of the empirical research is that it is hypothetical. Further research is required to determine actual uptake. Furthermore, because of the retrospective nature of the autopsy data set, findings regarding the likely contribution of organ sampling to final diagnosis are based on extrapolation of findings from historical autopsies, and prospective data collection is required to validate the conclusions. CONCLUSIONS LIA is viable and acceptable (except for unexplained deaths), and likely to increase uptake. Further health economic, performance and implementation studies are required to determine the optimal service configuration required to offer this as routine clinical care. FUNDING The National Institute for Health Research Health Technology Assessment programme.
Collapse
Affiliation(s)
- Celine Lewis
- North East Thames Regional Genetics Service, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,Genetics and Genomic Medicine, University College London Great Ormond Street Institute of Child Health, London, UK
| | - John C Hutchinson
- Department of Histopathology, Great Ormond Street Hospital for Children NHS Foundation Trust and Institute of Child Health/University College London, London, UK
| | - Megan Riddington
- Department of Psychological Services, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Melissa Hill
- North East Thames Regional Genetics Service, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,Genetics and Genomic Medicine, University College London Great Ormond Street Institute of Child Health, London, UK
| | - Owen J Arthurs
- Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | | | - Angie Wade
- Institute of Child Health; Population, Policy and Practice, University College London, London, UK
| | - Caroline J Doré
- Comprehensive Clinical Trials Unit, University College London, London, UK
| | - Lyn S Chitty
- North East Thames Regional Genetics Service, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,Genetics and Genomic Medicine, University College London Great Ormond Street Institute of Child Health, London, UK
| | - Neil J Sebire
- Department of Histopathology, Great Ormond Street Hospital for Children NHS Foundation Trust and Institute of Child Health/University College London, London, UK
| |
Collapse
|
11
|
Kang X, Carlin A, Cannie MM, Sanchez TC, Jani JC. Fetal postmortem imaging: an overview of current techniques and future perspectives. Am J Obstet Gynecol 2020; 223:493-515. [PMID: 32376319 DOI: 10.1016/j.ajog.2020.04.034] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 04/19/2020] [Accepted: 04/28/2020] [Indexed: 12/19/2022]
Abstract
Fetal death because of miscarriage, unexpected intrauterine fetal demise, or termination of pregnancy is a traumatic event for any family. Despite advances in prenatal imaging and genetic diagnosis, conventional autopsy remains the gold standard because it can provide additional information not available during fetal life in up to 40% of cases and this by itself may change the recurrence risk and hence future counseling for parents. However, conventional autopsy is negatively affected by procedures involving long reporting times because the fetal brain is prone to the effect of autolysis, which may result in suboptimal examinations, particularly of the central nervous system. More importantly, fewer than 50%-60% of parents consent to invasive autopsy, mainly owing to the concerns about body disfigurement. Consequently, this has led to the development of noninvasive perinatal virtual autopsy using imaging techniques. Because a significant component of conventional autopsy involves the anatomic examination of organs, imaging techniques such as magnetic resonance imaging, ultrasound, and computed tomography are possible alternatives. With a parental acceptance rate of nearly 100%, imaging techniques as part of postmortem examination have become widely used in recent years in some countries. Postmortem magnetic resonance imaging using 1.5-Tesla magnets is the most studied technique and offers an overall diagnostic accuracy of 77%-94%. It is probably the best choice as a virtual autopsy technique for fetuses >20 weeks' gestation. However, for fetuses <20 weeks' gestation, its performance is poor. The use of higher magnetic resonance imaging magnetic fields such as 3-Tesla may slightly improve performance. Of note, in cases of fetal maceration, magnetic resonance imaging may offer diagnoses in a proportion of brain lesions wherein conventional autopsy fails. Postmortem ultrasound examination using a high-frequency probe offers overall sensitivity and specificity of 67%-77% and 74%-90%, respectively, with the advantage of easy access and affordability. The main difference between postmortem ultrasound and magnetic resonance imaging relates to their respective abilities to obtain images of sufficient quality for a confident diagnosis. The nondiagnostic rate using postmortem ultrasound ranges from 17% to 30%, depending on the organ examined, whereas the nondiagnostic rate using postmortem magnetic resonance imaging in most situations is far less than 10%. For fetuses ≤20 weeks' gestation, microfocus computed tomography achieves close to 100% agreement with autopsy and is likely to be the technique of the future in this subgroup. The lack of histology has always been listed as 1 limitation of all postmortem imaging techniques. Image-guided needle tissue biopsy coupled with any postmortem imaging can overcome this limitation. In addition to describing the diagnostic accuracy and limitations of each imaging technology, we propose a novel, stepwise diagnostic approach and describe the possible application of these techniques in clinical practice as an alternative or an adjunct or for triage to select cases that would specifically benefit from invasive examination, with the aim of reducing parental distress and pathologist workload. The widespread use of postmortem fetal imaging is inevitable, meaning that hurdles such as specialized training and dedicated financing must be overcome to improve access to these newer, well-validated techniques.
Collapse
Affiliation(s)
- Xin Kang
- Departments of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Andrew Carlin
- Departments of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Mieke M Cannie
- Radiology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium; Department of Radiology, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Teresa Cos Sanchez
- Departments of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Jacques C Jani
- Departments of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium.
| |
Collapse
|
12
|
Garcia R, Ali N, Griffiths M, Randhawa G. A qualitative study exploring the experiences of bereavement after stillbirth in pakistani, bangladeshi and white british mothers living in luton, UK. Midwifery 2020; 91:102833. [PMID: 32898720 DOI: 10.1016/j.midw.2020.102833] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 07/07/2020] [Accepted: 08/28/2020] [Indexed: 10/23/2022]
Abstract
AIM This study aims to explore the experiences of bereavement after stillbirth of Pakistani, Bangladeshi and White British mothers in a town with multi-ethnic populations in England. PARTICIPANTS A purposive sample of Pakistani, Bangladeshi and White British mothers aged over 16 (at time of infant birth), who suffered a stillbirth in the preceding 6-24 months and residing in a specified postcode area were invited to take part in the study, by an identified gatekeeper (audit midwife) from the local National Health Service Trust, in addition to local bereavement charities. DESIGN Qualitative methods using face-to-face semi-structured interviews were undertaken, recorded and transcribed verbatim. Using framework analysis, several themes were identified. FINDINGS There were three main themes identified from the data; 1. knowledge and information of pregnancy and perinatal mortality; 2. attitudes and perceptions to pregnancy and perinatal mortality and 3. experiences with maternity care. The findings revealed mostly similarities in the bereavement experiences of the Pakistani, Bangladeshi and White British mothers. A few cultural and religious differences were identified. CONCLUSIONS This study found important similarities in bereavement experiences of Pakistani, Bangladeshi and White British mothers and highlights considerations for policy makers and maternity services in how the timing of bereavement after care is provided, including advice surrounding the infant post-mortem. 209.
Collapse
Affiliation(s)
- Rebecca Garcia
- Faculty of Health, Education and Languages, The Open University, Walton Hall, Milton Keynes, MK7 6AA.
| | - Nasreen Ali
- The Institute for Health Research, University of Bedfordshire, Putteridge Bury, Hitchin Road, Luton, Bedfordshire, LU2 8LE.
| | - Malcolm Griffiths
- Luton &Dunstable University Hospital NHS Foundation Trust, Lewsey Rd, Luton, LU4 0DZ.
| | - Gurch Randhawa
- The Institute for Health Research, University of Bedfordshire, Putteridge Bury, Hitchin Road, Luton, Bedfordshire, LU2 8LE.
| |
Collapse
|
13
|
Gibbins KJ, Pinar H, Reddy UM, Saade GR, Goldenberg RL, Dudley DJ, Drews-Botsch C, Freedman AA, Daniels LM, Parker CB, Thorsten V, Bukowski R, Silver RM. Findings in Stillbirths Associated with Placental Disease. Am J Perinatol 2020; 37:708-715. [PMID: 31087311 PMCID: PMC6854286 DOI: 10.1055/s-0039-1688472] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Placental disease is a leading cause of stillbirth. Our purpose was to characterize stillbirths associated with placental disease. STUDY DESIGN The Stillbirth Collaborative Research Network conducted a prospective, case-control study of stillbirths and live births from 2006 to 2008. This analysis includes 512 stillbirths with cause of death assignment and a comparison group of live births. We compared exposures between women with stillbirth due to placental disease and those due to other causes as well as between women with term (≥ 37 weeks) stillbirth due to placental disease and term live births. RESULTS A total of 121 (23.6%) out of 512 stillbirths had a probable or possible cause of death due to placental disease by Initial Causes of Fetal Death. Characteristics were similar between stillbirths due to placental disease and other stillbirths. When comparing term live births to stillbirths due to placental disease, women with non-Hispanic black race, Hispanic ethnicity, lack of insurance, or who were born outside of the United States had higher odds of stillbirth due to placental disease. Nulliparity and antenatal bleeding also increased risk of stillbirth due to placental disease. CONCLUSION Multiple discrete exposures were associated with stillbirth caused by placental disease. The relationship between these factors and utility of surveillance warrants further study.
Collapse
Affiliation(s)
| | - Halit Pinar
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Uma M. Reddy
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Dyregrov A, Kristensen P. Information to Bereaved Families Following Catastrophic Losses. Why Is It Important? JOURNAL OF LOSS & TRAUMA 2020. [DOI: 10.1080/15325024.2019.1710954] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Atle Dyregrov
- Faculty of Psychology, Center for Crisis Psychology, University of Bergen, Bergen, Norway
| | - Pål Kristensen
- Faculty of Psychology, Center for Crisis Psychology, University of Bergen, Bergen, Norway
| |
Collapse
|
15
|
Feroz A, Ali AS, Ibrahim MN, McClure EM, Tikmani SS, Reza S, Abbasi Z, Raza J, Yasmin H, Bano K, Zafar A, Siddiqi S, Goldenberg RL, Saleem S. Perceptions of health professionals regarding minimally invasive tissue sampling (MITS) to identify the cause of death in stillbirths and neonates: results from a qualitative study. Matern Health Neonatol Perinatol 2019; 5:17. [PMID: 31666979 PMCID: PMC6814094 DOI: 10.1186/s40748-019-0112-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 10/03/2019] [Indexed: 11/22/2022] Open
Abstract
Background Pakistan is considered to be one of the riskiest places in the world for childbirth as measured by its high stillbirth and neonatal mortality rates. Complete diagnostic autopsy remains the gold standard to determine the cause of death (CoD); however, it is not routinely implemented due to religious objections, sociocultural beliefs, limited resources and low demand from physicians and families. Recently, minimally invasive tissue sampling (MITS) using needle biopsies of multiple tissues to obtain tissue for histological examination and organism identification with PCR has been developed and promoted to determine CoD in low-resource areas. To ensure successful implementation of MITS, it is important to understand health professionals’ attitudes and perceptions related to MITS. Methods A qualitative study was conducted at the National Institute of Child Health (NICH), Karachi, Pakistan. Focus group discussions (FGDs) and Key-informant interviews (KIIs) were conducted with health professionals including doctors, nurses, trainees, clinicians, bioethics experts and public health experts to explore their perceptions and views on acceptability of MITS. Data were analyzed using NVivo 10 software. Results A total of 12 interviews (FGDs = 4; KIIs = 8) were conducted. Four overarching themes were identified: (I) acceptability of MITS; (II) perceived benefits of the MITS procedure; (III) factors facilitating the implementation of MITS; and (IV) health system requirements for implementing the MITS procedure. Generally, MITS was considered as a positive development for the health system. Diagnostic accuracy and identification of less common causes of death were highlighted as two main benefits of the MITS procedure. The study highlighted a number of facilitators for the acceptability of MITS including effective counseling, building trust with parents, fast procedure time, and approaching families within a few hours of death. In addition, lack of skilled staff, poorly equipped healthcare facilities and the potential high cost to conduct MITS were identified as challenges for the implementation of MITS. Conclusions This formative research provided a unique opportunity to explore health professionals’ views and attitudes towards the MITS procedure. Such insights are crucial to ensure successful implementation and integration of a new technique into the existing health system. The research identified the factors influencing the acceptability of MITS among health professionals in Pakistan. The study also informed factors that could help facilitate the implementation of the MITS procedures in the context of Pakistan and similar settings.
Collapse
Affiliation(s)
- Anam Feroz
- 1Department of Community Health Sciences, The Aga Khan University, Stadium Road, PO Box 3500, Karachi, 74800 Pakistan
| | - Anum Shiraz Ali
- 1Department of Community Health Sciences, The Aga Khan University, Stadium Road, PO Box 3500, Karachi, 74800 Pakistan
| | | | | | - Shiyam Sunder Tikmani
- 1Department of Community Health Sciences, The Aga Khan University, Stadium Road, PO Box 3500, Karachi, 74800 Pakistan
| | - Sayyeda Reza
- 1Department of Community Health Sciences, The Aga Khan University, Stadium Road, PO Box 3500, Karachi, 74800 Pakistan
| | - Zahid Abbasi
- 1Department of Community Health Sciences, The Aga Khan University, Stadium Road, PO Box 3500, Karachi, 74800 Pakistan
| | - Jamal Raza
- 2National Institute of Child Health, Karachi, Pakistan
| | - Haleema Yasmin
- 4Department of Obstetrics and Gynecology, Jinnah Post-graduate Medical Center, Karachi, Pakistan
| | - Khadija Bano
- 4Department of Obstetrics and Gynecology, Jinnah Post-graduate Medical Center, Karachi, Pakistan
| | - Afia Zafar
- 5Department of Pathology & Laboratory Medicine, The Aga Khan University, Stadium Road, PO Box 3500, Karachi, 74800 Pakistan
| | - Sameen Siddiqi
- 1Department of Community Health Sciences, The Aga Khan University, Stadium Road, PO Box 3500, Karachi, 74800 Pakistan
| | - Robert L Goldenberg
- 6Department of Obstetrics and Gynecology, Columbia University, New York, USA
| | - Sarah Saleem
- 1Department of Community Health Sciences, The Aga Khan University, Stadium Road, PO Box 3500, Karachi, 74800 Pakistan
| |
Collapse
|
16
|
Sauvegrain P, Carayol M, Piedvache A, Guéry E, Bucourt M, Zeitlin J. Low autopsy acceptance after stillbirth in a disadvantaged French district: a mixed methods study. BMC Pregnancy Childbirth 2019; 19:117. [PMID: 30953470 PMCID: PMC6451265 DOI: 10.1186/s12884-019-2261-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 03/25/2019] [Indexed: 11/11/2022] Open
Affiliation(s)
- Priscille Sauvegrain
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Maternité de Port Royal, 53, av. de l’Observatoire, 75014 Paris, France
- Department of Obstetrics and Gynecology, Pitié-Salpêtrière Hospital, AP-HP, Paris, France
| | - Marion Carayol
- Maternal and Infant Protection Service, Department of Families and Early Childhood, Paris, France
| | - Aurélie Piedvache
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Maternité de Port Royal, 53, av. de l’Observatoire, 75014 Paris, France
| | - Esther Guéry
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Maternité de Port Royal, 53, av. de l’Observatoire, 75014 Paris, France
| | - Martine Bucourt
- Fetopathology Unit, Jean Verdier Hospital, AP-HP, Bondy, France
| | - Jennifer Zeitlin
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Maternité de Port Royal, 53, av. de l’Observatoire, 75014 Paris, France
| |
Collapse
|
17
|
Lewis C, Riddington M, Hill M, Arthurs OJ, Hutchinson JC, Chitty LS, Bevan C, Fisher J, Ward J, Sebire NJ. Availability of less invasive prenatal, perinatal and paediatric autopsy will improve uptake rates: a mixed-methods study with bereaved parents. BJOG 2019; 126:745-753. [PMID: 30576088 PMCID: PMC6519272 DOI: 10.1111/1471-0528.15591] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2018] [Indexed: 11/30/2022]
Abstract
Objective To investigate whether less invasive methods of autopsy would be acceptable to bereaved parents and likely to increase uptake. Design Mixed methods study. Setting Bereaved parents recruited prospectively across seven hospitals in England and retrospectively through four parent support organisations. Sample Eight hundred and fifty‐nine surveys and 20 interviews with bereaved parents. Methods Cross‐sectional survey and qualitative semi‐structured telephone interviews. Main outcome measures Likely uptake, preferences, factors impacting decision‐making, views on different autopsy methods. Results Overall, 90.5% of participants indicated that they would consent to some form of less invasive autopsy [either minimally invasive autopsy (MIA), non‐invasive autopsy (NIA) or both]; 53.8% would consent to standard autopsy, 74.3% to MIA and 77.3% to NIA. Regarding parental preferences, 45.5% preferred MIA, 30.8% preferred NIA and 14.3% preferred standard autopsy. Participants who indicated they would decline standard autopsy but would consent to a less invasive option were significantly more likely to have a lower educational level (odds ratio 0.49; 95% CI 0.35–0.70; P = 0.000062). Qualitative findings suggest that parents value NIA because of the lack of any incision and MIA is considered a good compromise as it enables tissue sampling while easing the parental burden associated with consenting to standard autopsy. Conclusion Less invasive methods of autopsy are acceptable alternatives for bereaved parents, and if offered, are likely to increase uptake and improve parental experience. Further health economic, validation and implementation studies are now required to assess the viability of offering these in routine widespread clinical care. Tweetable abstract Mixed methods UK study finds less invasive methods of autopsy are acceptable alternatives for bereaved parents, and if offered, are likely to increase uptake and improve parental experience. Mixed methods UK study finds less invasive methods of autopsy are acceptable alternatives for bereaved parents, and if offered, are likely to increase uptake and improve parental experience.
Collapse
Affiliation(s)
- C Lewis
- North East Thames Regional Genetics Service, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK.,Genetics and Genomic Medicine, The UCL Great Ormond Street Institute of Child Health, London, UK
| | - M Riddington
- Department of Psychological Services, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - M Hill
- North East Thames Regional Genetics Service, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK.,Genetics and Genomic Medicine, The UCL Great Ormond Street Institute of Child Health, London, UK
| | - O J Arthurs
- Department of Radiology, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - J C Hutchinson
- Department of Histopathology, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - L S Chitty
- North East Thames Regional Genetics Service, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK.,Genetics and Genomic Medicine, The UCL Great Ormond Street Institute of Child Health, London, UK
| | - C Bevan
- Stillbirth and neonatal death charity (Sands), London, UK
| | - J Fisher
- Antenatal Results and Choices (ARC), London, UK
| | - J Ward
- The Lullaby Trust, London, UK
| | - N J Sebire
- Department of Histopathology, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK.,The UCL Great Ormond Street Institute of Child Health, London, UK
| |
Collapse
|
18
|
de Sévaux JLH, Nikkels PGJ, Lequin MH, Groenendaal F. The Value of Autopsy in Neonates in the 21st Century. Neonatology 2019; 115:89-93. [PMID: 30352441 PMCID: PMC6425852 DOI: 10.1159/000493003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Accepted: 08/17/2018] [Indexed: 01/04/2023]
Abstract
BACKGROUND Autopsy rates in neonatal intensive care unit (NICU) patients who died are declining worldwide. Postmortem magnetic resonance imaging (MRI) is suggested as adjunct to or substitute for autopsy. OBJECTIVE The aim of this paper was to determine the additional diagnostic value of autopsy in NICU patients and whether autopsy findings were potentially detectable using postmortem MRI. METHODS From 2008 to 2015, 298 infants died during admission to our NICU. Permission for unrestricted, nonforensic autopsy was obtained in 100 (33.6%) of these 298 infants. Retrospectively, autopsy reports and medical records of NICU patients were compared. Additional autopsy findings were graded according to the Goldman system, grading the clinical relevance of additional findings. In addition, the potential detectability of these additional findings on postmortem MRI was assessed. RESULTS Additional findings obtained by autopsy were found in 48% of the cases, divided into major (Goldman I/II, 24%) and minor (Goldman III/IV, 24%) additional findings. Major additional findings were significantly more often found in patients with a lower gestational age, and minor additional findings in patients with a higher postnatal age at death. Of all patients with additional findings determined by autopsy, 56.3% would most likely not have been detected using postmortem MRI. CONCLUSIONS Our results emphasize the still very important role of autopsy in the NICU setting and show that conventional autopsy could probably not be completely substituted by postmortem MRI.
Collapse
Affiliation(s)
- Joline L H de Sévaux
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Peter G J Nikkels
- Department of Pathology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Maarten H Lequin
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Floris Groenendaal
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, The
| |
Collapse
|
19
|
Lewis C, Latif Z, Hill M, Riddington M, Lakhanpaul M, Arthurs OJ, Hutchinson JC, Chitty LS, Sebire NJ. "We might get a lot more families who will agree": Muslim and Jewish perspectives on less invasive perinatal and paediatric autopsy. PLoS One 2018; 13:e0202023. [PMID: 30092056 PMCID: PMC6085003 DOI: 10.1371/journal.pone.0202023] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 07/26/2018] [Indexed: 11/23/2022] Open
Abstract
Background Perinatal and paediatric autopsy rates are at historically low levels with declining uptake due to dislike of the invasiveness of the procedure, and religious objections particularly amongst Muslim and Jewish parents. Less invasive methods of autopsy including imaging with and without tissue sampling have been shown to be feasible alternatives. We sought to investigate attitudes including religious permissibility and potential uptake amongst members of the Muslim and Jewish communities in the United Kingdom. Methods Semi-structured interviews with religious and faith-based authorities (n = 16) and bereaved parents from the Jewish community (n = 3) as well as 10 focus groups with community members (60 Muslim participants and 16 Jewish participants) were conducted. Data were analysed using thematic analysis to identify key themes. Findings Muslim and Jewish religious and faith-based authorities agreed that non-invasive autopsy with imaging was religiously permissible because it did not require incisions or interference with the body. A minimally invasive approach was less acceptable as it still required incisions to the body, although in those circumstances where it was required by law it was more acceptable than a full autopsy. During focus group discussions with community members, the majority of participants indicated they would potentially consent to a non-invasive autopsy if the body could be returned for burial within 24 hours, or if a family had experienced multiple fetal/pregnancy losses and the information gained might be useful in future pregnancies. Minimally invasive autopsy was less acceptable but around half of participants might consent if a non-invasive autopsy was not suitable, with the exception of the Jewish Haredi community who unanimously stated they would decline this alternative. Conclusions Our research suggests less invasive autopsy offers a viable alternative to many Muslim and Jewish parents in the UK who currently decline a full autopsy. The findings may be of importance to other countries with significant Muslim and/or Jewish communities as well as to other religious communities where concerns around autopsy exist. Awareness-raising amongst religious leaders and community members will be important if these methods become routinely available.
Collapse
Affiliation(s)
- Celine Lewis
- North East Thames Regional Genetics Service, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
- Genetics and Genomic Medicine, The UCL Great Ormond Street Institute of Child Health, London, United Kingdom
- * E-mail:
| | - Zahira Latif
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
- School of Medicine, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, United Kingdom
| | - Melissa Hill
- North East Thames Regional Genetics Service, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
- Genetics and Genomic Medicine, The UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Megan Riddington
- Department of Psychological Services, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Monica Lakhanpaul
- Faculty of Population Health Sciences, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
- Community Paediatrics, Whittington Health NHS Trust, London, United Kingdom
| | - Owen J. Arthurs
- Faculty of Population Health Sciences, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
- Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - John C. Hutchinson
- Department of Histopathology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Lyn S. Chitty
- North East Thames Regional Genetics Service, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
- Genetics and Genomic Medicine, The UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Neil J. Sebire
- Department of Histopathology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| |
Collapse
|
20
|
Abstract
OBJECTIVES The acceptability of traditional postmortem examination to bereaved families, coupled with a misguided professional view about their limited utility, has led to decrease in this ultimate investigation. Research recurrently demonstrates that postmortem examination provides clinically relevant information despite ever-improving diagnostic techniques. This review examines postmortem examination for children who die in PICU-whether consented or nonconsented (legally mandated). It explores how such investigations might provide useful information and suggests that PICU and pathology teams work together to provide information for bereaved families to either enable them to consent to postmortem interventions or understand necessary forensic processes. Newer technologies such as postmortem imaging and laparoscope-assisted/ultrasound-guided tissue sampling are reviewed, with the hope that greater acceptability to families may lead to a welcome resurgence in postmortem information for clinicians, tempered by realization that widespread acceptance of their equivalence to standard techniques by most forensic services is awaited. DATA SOURCES Literature review. STUDY SELECTION Journal articles describing practices in pediatric and adult postmortem examination. DATA EXTRACTION Not available. DATA SYNTHESIS Not available. CONCLUSIONS The PICU team have a duty to help bereaved parents understand what postmortem investigations are available, or might be mandated, after the death of their child. A thoughtful, unhurried, and compassionate discussion should be arranged with expert pathology teams and any specialists who have cared for the child to explain how investigations can provide information about what is involved-including availability and suitability of newer techniques. This should include information about when a child's body, organs, or tissues will be available for the funeral, necessary legal procedures and how and when results will be explained to them.
Collapse
|
21
|
Lewis C, Hill M, Arthurs OJ, Hutchinson JC, Chitty LS, Sebire N. Health professionals' and coroners' views on less invasive perinatal and paediatric autopsy: a qualitative study. Arch Dis Child 2018; 103:572-578. [PMID: 29438963 PMCID: PMC5965355 DOI: 10.1136/archdischild-2017-314424] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 01/18/2018] [Accepted: 01/22/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To assess health professionals' and coroners' attitudes towards non-minimally and minimally invasive autopsy in the perinatal and paediatric setting. METHODS A qualitative study using semistructured interviews. Data were analysed thematically. RESULTS Twenty-five health professionals (including perinatal/paediatric pathologists and anatomical pathology technologists, obstetricians, fetal medicine consultants and bereavement midwives, intensive care consultants and family liaison nurses, a consultant neonatologist and a paediatric radiologist) and four coroners participated. Participants viewed less invasive methods of autopsy as a positive development in prenatal and paediatric care that could increase autopsy rates. Several procedural and psychological benefits were highlighted including improved diagnostic accuracy in some circumstances, potential for faster turnaround times, parental familiarity with imaging and laparoscopic approaches, and benefits to parents and faith groups who object to invasive approaches. Concerns around the limitations of the technology such not reaching the same levels of certainty as full autopsy, unsuitability of imaging in certain circumstances, the potential for missing a diagnosis (or misdiagnosis) and de-skilling the workforce were identified. Finally, a number of implementation issues were raised including skills and training requirements for pathologists and radiologists, access to scanning equipment, required computational infrastructure, need for a multidisciplinary approach to interpret results, cost implications, equity of access and acceptance from health professionals and hospital managers. CONCLUSION Health professionals and coroners viewed less invasive autopsy as a positive development in perinatal and paediatric care. However, to inform implementation a detailed health economic analysis and further exploration of parental views, particularly in different religious groups, are required.
Collapse
Affiliation(s)
- Celine Lewis
- North East Thames Regional Genetics Service, Great Ormond Street Hospital, NHS Foundation Trust, London, UK,Genetics and Genomic Medicine, The UCL Great Ormond Street Institute of Child Health, London, UK
| | - Melissa Hill
- North East Thames Regional Genetics Service, Great Ormond Street Hospital, NHS Foundation Trust, London, UK,Genetics and Genomic Medicine, The UCL Great Ormond Street Institute of Child Health, London, UK
| | - Owen J Arthurs
- Genetics and Genomic Medicine, The UCL Great Ormond Street Institute of Child Health, London, UK,Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - John C Hutchinson
- Genetics and Genomic Medicine, The UCL Great Ormond Street Institute of Child Health, London, UK,Department of Histopathology, Great Ormond Street Hospital For Children NHS Trust, London, UK
| | - Lyn S Chitty
- North East Thames Regional Genetics Service, Great Ormond Street Hospital, NHS Foundation Trust, London, UK,Genetics and Genomic Medicine, The UCL Great Ormond Street Institute of Child Health, London, UK
| | - Neil Sebire
- Genetics and Genomic Medicine, The UCL Great Ormond Street Institute of Child Health, London, UK,Department of Histopathology, Great Ormond Street Hospital For Children NHS Trust, London, UK
| |
Collapse
|
22
|
Wojcieszek AM, Shepherd E, Middleton P, Gardener G, Ellwood DA, McClure EM, Gold KJ, Khong TY, Silver RM, Erwich JJHM, Flenady V. Interventions for investigating and identifying the causes of stillbirth. Cochrane Database Syst Rev 2018; 4:CD012504. [PMID: 29709055 PMCID: PMC6494629 DOI: 10.1002/14651858.cd012504.pub2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Identification of the causes of stillbirth is critical to the primary prevention of stillbirth and to the provision of optimal care in subsequent pregnancies. A wide variety of investigations are available, but there is currently no consensus on the optimal approach. Given their cost and potential to add further emotional burden to parents, there is a need to systematically assess the effect of these interventions on outcomes for parents, including psychosocial outcomes, economic costs, and on rates of diagnosis of the causes of stillbirth. OBJECTIVES To assess the effect of different tests, protocols or guidelines for investigating and identifying the causes of stillbirth on outcomes for parents, including psychosocial outcomes, economic costs, and rates of diagnosis of the causes of stillbirth. SEARCH METHODS We searched Cochrane Pregnancy and Childbirth's Trials Register (31 August 2017), ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform (ICTRP) (15 May 2017). SELECTION CRITERIA We planned to include randomised controlled trials (RCTs), quasi-RCTs, and cluster-RCTs. We planned to include studies published as abstract only, provided there was sufficient information to allow us to assess study eligibility. We planned to exclude cross-over trials.Participants included parents (including mothers, fathers, and partners) who had experienced a stillbirth of 20 weeks' gestation or greater.This review focused on interventions for investigating and identifying the causes of stillbirth. Such interventions are likely to be diverse, but could include:* review of maternal and family history, and current pregnancy and birth history;* clinical history of present illness;* maternal investigations (such as ultrasound, amniocentesis, antibody screening, etc.);* examination of the stillborn baby (including full autopsy, partial autopsy or noninvasive components, such as magnetic resonance imaging (MRI), computerised tomography (CT) scanning, and radiography);* umbilical cord examination;* placental examination including histopathology (microscopic examination of placental tissue); and* verbal autopsy (interviews with care providers and support people to ascertain causes, without examination of the baby).We planned to include trials assessing any test, protocol or guideline (or combinations of tests/protocols/guidelines) for investigating the causes of stillbirth, compared with the absence of a test, protocol or guideline, or usual care (further details are presented in the Background, see Description of the intervention).We also planned to include trials comparing any test, protocol or guideline (or combinations of tests/protocols/guidelines) for investigating the causes of stillbirth with another, for example, the use of a limited investigation protocol compared with a comprehensive investigation protocol. DATA COLLECTION AND ANALYSIS Two review authors assessed trial eligibility independently. MAIN RESULTS We excluded five studies that were not RCTs. There were no eligible trials for inclusion in this review. AUTHORS' CONCLUSIONS There is currently a lack of RCT evidence regarding the effectiveness of interventions for investigating and identifying the causes of stillbirth. Seeking to determine the causes of stillbirth is an essential component of quality maternity care, but it remains unclear what impact these interventions have on the psychosocial outcomes of parents and families, the rates of diagnosis of the causes of stillbirth, and the care and management of subsequent pregnancies following stillbirth. Due to the absence of trials, this review is unable to inform clinical practice regarding the investigation of stillbirths, and the specific investigations that would determine the causes.Future RCTs addressing this research question would be beneficial, but the settings in which the trials take place, and their design, need to be given careful consideration. Trials need to be conducted with the utmost care and consideration for the needs, concerns, and values of parents and families. Assessment of longer-term psychosocial variables, economic costs to health services, and effects on subsequent pregnancy care and outcomes should also be considered in any future trials.
Collapse
Affiliation(s)
- Aleena M Wojcieszek
- Mater Research Institute ‐ The University of Queensland (MRI‐UQ)NHMRC Centre of Research Excellence in StillbirthLevel 3 Aubigny PlaceMater Health ServicesBrisbaneQueenslandAustralia4101
| | - Emily Shepherd
- The University of AdelaideARCH: Australian Research Centre for Health of Women and Babies, Robinson Research Institute, Discipline of Obstetrics and GynaecologyAdelaideSouth AustraliaAustralia5006
| | - Philippa Middleton
- Healthy Mothers, Babies and Children, South Australian Health and Medical Research InstituteWomen's and Children's Hospital72 King William RoadAdelaideSouth AustraliaAustralia5006
| | - Glenn Gardener
- Mater Mothers' HospitalDepartment of Maternal Fetal MedicineRaymond TerraceBrisbaneQueenslandAustralia4101
| | - David A Ellwood
- Griffith UniversitySchool of MedicineGold Coast CampusLevel 8, G40Gold CoastQueensland,Australia4216
| | - Elizabeth M McClure
- Research Triangle InstituteDepartment of Maternal and Child Health3040 East Cornwallis RoadResearch Triangle ParkNCUSA27709
| | - Katherine J Gold
- University of MichiganDepartment of Family Medicine; Department of Obstetrics and Gynecology1018 Fuller StreetAnn ArborMichiganUSA48104 1213
| | - Teck Yee Khong
- Women's and Children's HospitalSA Pathology72 King William RoadAdelaideSouth AustraliaAustralia5006
| | - Robert M Silver
- University of UtahDivision of Maternal‐Fetal Medicine, Health Services Center30 North 1900 East SOM 2B200Salt Lake CityUtahUSA84132
| | - Jan Jaap HM Erwich
- University of Groningen, University Medical Center GroningenDepartment of Obstetrics and GynecologyHanzeplein 1GroningenNetherlands9700 RB
| | - Vicki Flenady
- Mater Research Institute ‐ The University of Queensland (MRI‐UQ)NHMRC Centre of Research Excellence in StillbirthLevel 3 Aubigny PlaceMater Health ServicesBrisbaneQueenslandAustralia4101
| | | |
Collapse
|
23
|
Cronin RS, Li M, Wise M, Bradford B, Culling V, Zuccollo J, Thompson JMD, Mitchell EA, McCowan LME. Late stillbirth post mortem examination in New Zealand: Maternal decision-making. Aust N Z J Obstet Gynaecol 2018; 58:667-673. [PMID: 29505671 DOI: 10.1111/ajo.12790] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Accepted: 01/25/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND For parents who experience stillbirth, knowing the cause of their baby's death is important. A post mortem examination is the gold standard investigation, but little is known about what may influence parents' decisions to accept or decline. AIM We aimed to identify factors influencing maternal decision-making about post mortem examination after late stillbirth. METHODS In the New Zealand Multicentre Stillbirth Study, 169 women with singleton pregnancies, no known abnormality at recruitment, and late stillbirth (≥28weeks gestation), from seven health regions were interviewed within six weeks of birth. The purpose of this paper was to explore factors related to post mortem examination decision-making and the reasons for declining. We asked women if they would make the same decision again. RESULTS Maternal decision to decline a post mortem (70/169, 41.4%) was more common among women of Māori (adjusted odds ratio (aOR) 4.99 95% confidence interval (CI) 1.70-14.64) and Pacific (aOR 3.94 95% CI 1.47-10.54) ethnicity compared to European, and parity two or more (aOR 2.95 95% CI 1.14-7.62) compared to primiparous. The main reason for declining was that women 'did not want baby to be cut'. Ten percent (7/70) who declined said they would not make this decision again. No woman who consented regretted her decision. CONCLUSION Ethnic differences observed in women's post mortem decision-making should be further explored in future studies. Providing information of the effect of post mortem on the baby's body and the possible emotional benefits of a post mortem may assist women faced with this decision in the future.
Collapse
Affiliation(s)
- Robin S Cronin
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - Minglan Li
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - Michelle Wise
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - Billie Bradford
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | | | - Jane Zuccollo
- Labplus, Auckland District Health Board, Auckland, New Zealand
| | - John M D Thompson
- Department of Paediatrics: Child Health and Youth Health, University of Auckland, Auckland, New Zealand
| | - Edwin A Mitchell
- Department of Paediatrics: Child Health and Youth Health, University of Auckland, Auckland, New Zealand
| | - Lesley M E McCowan
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| |
Collapse
|
24
|
Shruthi M, Gupta N, Jana M, Mridha AR, Kumar A, Agarwal R, Sharma R, Deka D, Gupta AK, Kabra M. Conventional vs virtual autopsy with postmortem MRI in phenotypic characterization of stillbirths and fetal malformations. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2018; 51:236-245. [PMID: 28295775 DOI: 10.1002/uog.17468] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 01/25/2017] [Accepted: 02/28/2017] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To compare virtual autopsy using postmortem magnetic resonance imaging (MRI) with conventional autopsy with respect to phenotypic characterization of stillbirths and malformed fetuses, and acceptability to parents. METHODS This was a prospective diagnostic evaluation study, conducted from June 2013 to June 2015, including stillbirths and pregnancies terminated owing to fetal malformation at ≥ 20 weeks' gestation, for which parental consent to both conventional autopsy and postmortem MRI was obtained. Cases of maternal and obstetric cause of fetal demise were excluded. Whole-body postmortem MRI (at 1.5 T) was performed prior to conventional autopsy. Taking conventional autopsy as the diagnostic gold standard, postmortem MRI findings alone, or in conjunction with other minimally invasive prenatal and postmortem investigations, were assessed and compared for diagnostic accuracy. RESULTS Parental consent for both conventional autopsy and postmortem MRI was obtained in 52 cases of which 43 were included in the analysis. In 35 (81.4%) cases, the final diagnosis based on virtual autopsy with postmortem MRI was in agreement with that of conventional autopsy. With conventional autopsy as the reference standard, sensitivity, specificity, positive and negative predictive values of postmortem MRI were, respectively: 77.7%, 99.8%, 97.4% and 98.0% for whole-body assessment; 93.1%, 99.0%, 87.1% and 99.5% for the nervous system; 61.0%, 100.0%, 100.0% and 96.7% for the cardiovascular system; 91.1%, 100.0%, 100.0% and 98.0% for the pulmonary system; 80.6%, 99.8%, 96.7% and 98.7% for the abdomen; 96.2%, 99.7%, 96.2% and 99.7% for the renal system; and 66.7%, 100.0%, 100.0% and 97.2% for the musculoskeletal system. Virtual autopsy was acceptable to 96.8% of families as compared with conventional autopsy to 82.5%. CONCLUSIONS Virtual autopsy using postmortem MRI and other minimally invasive investigations can be an acceptable alternative to conventional autopsy when the latter is refused by the parents. Postmortem MRI is more acceptable to parents and can provide additional diagnostic information on brain and spinal cord malformations. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
Collapse
Affiliation(s)
- M Shruthi
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - N Gupta
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - M Jana
- Department of Radio Diagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - A R Mridha
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - A Kumar
- Department of Radio Diagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - R Agarwal
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - R Sharma
- Department of Radio Diagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - D Deka
- Fetal Medicine Division, Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - A K Gupta
- Department of Radio Diagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - M Kabra
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
25
|
Rodewald AK, Bode P, Cathomas G, Moch H. Klinische Obduktionen in der Schweiz. DER PATHOLOGE 2017; 38:416-421. [DOI: 10.1007/s00292-017-0323-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
|
26
|
Henderson J, Redshaw M. Parents' experience of perinatal post-mortem following stillbirth: A mixed methods study. PLoS One 2017; 12:e0178475. [PMID: 28586361 PMCID: PMC5460845 DOI: 10.1371/journal.pone.0178475] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 05/13/2017] [Indexed: 11/30/2022] Open
Abstract
Objectives To analyse quantitative and qualitative data, to describe the experience of parents in relation to post-mortem following stillbirth, looking at offer and uptake of post-mortem, information-giving, the type of post-mortem carried out, receiving the results and any sociodemographic differences in care practices in relation to post-mortem. Design Secondary analysis of a postal survey which included both open and closed questions allowing for a mixed methods study design. Population Random sample of women who experienced a stillbirth in 2013. Methods A sample of women who experienced a stillbirth in 2013 were selected by staff at the Office for National Statistics and sent a letter and information leaflet about the study followed by a postal questionnaire. The questionnaire included questions about pregnancy, labour and birth, the postnatal period, the time at which the baby died, and also asked about the post-mortem process. Results Completed questionnaires were received from 477 women. Overall, 95% of women were asked for consent to a post-mortem, almost half prior to birth, and half by a consultant. The majority of women received written information and felt sufficiently informed, and agreed to a full post-mortem. A third of women had to wait longer than 12 weeks for the post-mortem result and this was the most common theme in the free text comments. Women also commented on the manner of being asked for consent, and wrote about issues related to communication and support. There were significant differences between sociodemographic groups in many of these factors. Conclusions The inconsistencies in offer and consent to post-mortem following stillbirth suggest inequality in this area. The amount of time that many parents have to wait for post-mortem results is unacceptable and should be prioritised for improvement.
Collapse
Affiliation(s)
- Jane Henderson
- Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Maggie Redshaw
- Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
- * E-mail:
| |
Collapse
|
27
|
Lewis C, Hill M, Arthurs OJ, Hutchinson C, Chitty LS, Sebire NJ. Factors affecting uptake of postmortem examination in the prenatal, perinatal and paediatric setting. BJOG 2017; 125:172-181. [PMID: 28190300 PMCID: PMC5763339 DOI: 10.1111/1471-0528.14600] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2017] [Indexed: 11/30/2022]
Abstract
Background Postmortem examination is the single most useful investigation in providing information to parents about why their baby or child died. Despite this, uptake remains well below the recommended 75%. Objective To address the question ‘what are the barriers and motivators to perinatal, prenatal and paediatric PM examination?’ Search strategy Key databases including Pubmed and CINAHL; Cochrane library, websites of relevant patient organisations, hand search of key journals, first and last authors and references. Selection criteria Peer‐reviewed qualitative, quantitative or mixed methods research examining factors affecting uptake or decline of perinatal or paediatric postmortem examination. Data collection and analysis Narrative synthesis; findings were compared across studies to examine interrelations. Main results Seven major themes describing barriers to postmortem uptake were identified: dislike of invasiveness, practicalities of the procedure, organ retention issues, protective parenting, communication and understanding, religion and culture and professional or organisational barriers. Six major themes related to factors which facilitated parental consent were identified: desire for information, contributing to research, coping and well‐being, respectful care, minimally invasive options, and policy and practice. There were a number of themes in the literature that reflected best practice. Conclusion Findings highlight the need for better health professional education and the fact some concerns may be mitigated if less invasive methods of postmortem were routinely available. New consent packages and codes of practice may have a positive impact on perception of examination after death. The landscape is changing; further research is necessary to assess the impact on postmortem uptake rates. Tweetable abstract Systematic review to explore the barriers and motivators to perinatal, prenatal and paediatric postmortem examination. Systematic review to explore the barriers and motivators to perinatal, prenatal and paediatric postmortem examination.
Collapse
Affiliation(s)
- C Lewis
- North East Thames Regional Genetics Service, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,UCL Institute of Child Health, Great Ormond Street Institute of Child Health, London, UK
| | - M Hill
- North East Thames Regional Genetics Service, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,UCL Institute of Child Health, Great Ormond Street Institute of Child Health, London, UK
| | - O J Arthurs
- UCL Institute of Child Health, Great Ormond Street Institute of Child Health, London, UK.,Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - C Hutchinson
- UCL Institute of Child Health, Great Ormond Street Institute of Child Health, London, UK.,Department of Histopathology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - L S Chitty
- North East Thames Regional Genetics Service, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,UCL Institute of Child Health, Great Ormond Street Institute of Child Health, London, UK
| | - N J Sebire
- UCL Institute of Child Health, Great Ormond Street Institute of Child Health, London, UK.,Department of Histopathology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| |
Collapse
|
28
|
Whole-Body MRI Virtual Autopsy Using Diffusion-weighted Imaging With Background Suppression (DWIBS) at 3 T in a Child Succumbing to Chordoma. J Pediatr Hematol Oncol 2017; 39:133-136. [PMID: 28060123 DOI: 10.1097/mph.0000000000000759] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND We report the use of diffusion-weighted imaging with background suppression (DWIBS) in pediatric virtual magnetic resonance imaging (MRI) autopsy of a child who succumbed to chordoma. CASE DESCRIPTION A 10-year-old girl who succumbed to relapse of a chordoma underwent whole-body virtual MRI autopsy 12 hours postmortem with short Tau inversion recovery (STIR) and DWIBS on 3 T, which demonstrated the primary mass, local and cardiac invasion, and metastatic disease to the thorax, abdomen, head/neck, and musculoskeletal system. CONCLUSIONS Postmortem virtual MRI autopsy including DWIBS successfully demonstrated the transthoracic spread of chordoma and invasion of the heart, resulting in blood-borne metastases. Motion and respiratory artifact were not factors during virtual autopsy using DWIBS on 3 T, making ideal use of this technology.
Collapse
|
29
|
Wojcieszek AM, Shepherd E, Middleton P, Gardener G, Ellwood DA, McClure EM, Gold KJ, Khong TY, Silver RM, Erwich JJHM, Flenady V. Interventions for investigating and identifying the causes of stillbirth. Hippokratia 2017. [DOI: 10.1002/14651858.cd012504] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Aleena M Wojcieszek
- Mater Research Institute - The University of Queensland (MRI-UQ); Stillbirth Research Team; Level 2 Aubigny Place Mater Health Services Brisbane Queensland Australia 4101
| | - Emily Shepherd
- The University of Adelaide; ARCH: Australian Research Centre for Health of Women and Babies, Robinson Research Institute, Discipline of Obstetrics and Gynaecology; Adelaide South Australia Australia 5006
| | - Philippa Middleton
- Healthy Mothers, Babies and Children, South Australian Health and Medical Research Institute; Women's and Children's Hospital 72 King William Road Adelaide South Australia Australia 5006
| | - Glenn Gardener
- Mater Mothers' Hospital; Department of Maternal Fetal Medicine; Raymond Terrace Brisbane Queensland Australia 4101
| | - David A Ellwood
- Griffith University; School of Medicine; Gold Coast Campus Level 8, G40 Gold Coast Queensland, Australia 4216
| | - Elizabeth M McClure
- Research Triangle Institute; Department of Maternal and Child Health; 3040 East Cornwallis Road Research Triangle Park NC USA 27709
| | - Katherine J Gold
- University of Michigan; Department of Family Medicine; Department of Obstetrics and Gynecology; 1018 Fuller Street Ann Arbor Michigan USA 48104 1213
| | - Teck Yee Khong
- Women's and Children's Hospital; SA Pathology; 72 King William Road Adelaide South Australia Australia 5006
| | - Robert M Silver
- University of Utah; Division of Maternal-Fetal Medicine, Health Services Center; 30 North 1900 East SOM 2B200 Salt Lake City Utah USA 84132
| | - Jan Jaap HM Erwich
- Rijks Universiteit Groningen; Department of Obstetrics and Gynecology; Hanzeplein 1 Groningen Netherlands 9700 RB
| | - Vicki Flenady
- Mater Research Institute - The University of Queensland (MRI-UQ); Stillbirth Research Team; Level 2 Aubigny Place Mater Health Services Brisbane Queensland Australia 4101
| |
Collapse
|
30
|
Widmann R, Caduff R, Giudici L, Zhong Q, Vogetseder A, Arlettaz R, Frey B, Moch H, Bode PK. Value of postmortem studies in deceased neonatal and pediatric intensive care unit patients. Virchows Arch 2016; 470:217-223. [DOI: 10.1007/s00428-016-2056-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 11/03/2016] [Accepted: 12/08/2016] [Indexed: 10/20/2022]
|
31
|
Eutsler EP, Khanna G. Whole-body magnetic resonance imaging in children: technique and clinical applications. Pediatr Radiol 2016; 46:858-72. [PMID: 27229503 DOI: 10.1007/s00247-016-3586-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Revised: 01/20/2016] [Accepted: 02/11/2016] [Indexed: 11/28/2022]
Abstract
Whole-body MR imaging is being increasingly used in children to evaluate the extent of various oncologic and non-oncologic entities. The lack of exposure to ionizing radiation, excellent soft-tissue contrast (even without the use of contrast agents), and functional imaging capabilities make it especially suitable for screening and surveillance in the pediatric population. Technical developments such as moving table platforms, multi-channel/multi-element surface coils, and parallel imaging allow imaging of the entire body with multiple sequences in a reasonable 30- to 40-min time frame, which has facilitated its acceptance in routine clinical practice. The initial investigations in whole-body MR imaging were primarily focused on oncologic applications such as tumor screening and staging. The exquisite sensitivity of fluid-sensitive MR sequences to many different types of pathology has led to new applications of whole-body MR imaging in evaluation of multifocal rheumatologic conditions. Availability of blood pool contrast agents has allowed whole-body MR angiographic imaging of vascular malformations, vasculitides and vasculopathies. Whole-body MRI is being applied for delineating the extent and distribution of systemic and multifocal diseases, establishing diagnoses, assessing treatment response, and surveillance imaging. This article reviews the technique and clinical applications of whole-body MR imaging in children.
Collapse
Affiliation(s)
- Eric P Eutsler
- Mallinckrodt Institute of Radiology, Campus Box 8131, 510 S. Kingshighway, St. Louis, MO, 63110, USA.,Washington University School of Medicine, St. Louis, MO, USA
| | - Geetika Khanna
- Mallinckrodt Institute of Radiology, Campus Box 8131, 510 S. Kingshighway, St. Louis, MO, 63110, USA. .,Washington University School of Medicine, St. Louis, MO, USA.
| |
Collapse
|
32
|
Ellis A, Chebsey C, Storey C, Bradley S, Jackson S, Flenady V, Heazell A, Siassakos D. Systematic review to understand and improve care after stillbirth: a review of parents' and healthcare professionals' experiences. BMC Pregnancy Childbirth 2016; 16:16. [PMID: 26810220 PMCID: PMC4727309 DOI: 10.1186/s12884-016-0806-2] [Citation(s) in RCA: 160] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 01/18/2016] [Indexed: 11/16/2022] Open
Abstract
Background 2.7 million babies were stillborn in 2015 worldwide; behind these statistics lie the experiences of bereaved parents. The first Lancet series on stillbirth in 2011 described stillbirth as one of the “most shamefully neglected” areas of public health, recommended improving interaction between families and frontline caregivers and made a plea for increased investment in relevant research. Methods A systematic review of qualitative, quantitative and mixed-method studies researching parents and healthcare professionals experiences of care after stillbirth in high-income westernised countries (Europe, North America, Australia and South Africa) was conducted. The review was designed to inform research, training and improve care for parents who experience stillbirth. Results Four thousand four hundred eighty eight abstracts were identified; 52 studies were eligible for inclusion. Synthesis and quantitative aggregation (meta-summary) was used to extract findings and calculate frequency effect sizes (FES%) for each theme (shown in italics), a measure of the prevalence of that finding in the included studies. Researchers’ areas of interest may influence reporting of findings in the literature and result in higher FES sizes, such as; support memory making (53 %) and fathers have different needs (18 %). Other parental findings were more unexpected; Parents want increased public awareness (20 %) and for stillbirth care to be prioritised (5 %). Parental findings highlighted lessons for staff; prepare parents for vaginal birth (23 %), discuss concerns (13 %), give options & time (20 %), privacy not abandonment (30 %), tailored post-mortem discussions (20 %) and post-natal information (30 %). Parental and staff findings were often related; behaviours and actions of staff have a memorable impact on parents (53 %) whilst staff described emotional, knowledge and system-based barriers to providing effective care (100 %). Parents reported distress being caused by midwives hiding behind ‘doing’ and ritualising guidelines whilst staff described distancing themselves from parents and focusing on tasks as coping strategies. Parents and staff both identified the need for improved training (parents 25 % & staff 57 %); continuity of care (parents 15 % & staff 36 %); supportive systems & structures (parents 50 %); and clear care pathways (parents 5 %). Conclusions Parents’ and healthcare workers’ experiences of stillbirth can inform training, improve the provision of care and highlight areas for future research. Electronic supplementary material The online version of this article (doi:10.1186/s12884-016-0806-2) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Alison Ellis
- Obstetrics and Gynaecology, Southmead Hospital, Westbury on Trym, Bristol, BS10 5NB, UK.
| | - Caroline Chebsey
- Obstetrics and Gynaecology, Southmead Hospital, Westbury on Trym, Bristol, BS10 5NB, UK
| | | | | | | | - Vicki Flenady
- Mater Research Institute -The University of Queensland (MRI-UQ), Brisbane, Australia
| | - Alexander Heazell
- Institute of Human Development, Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK.,St. Mary's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, M13 9WL, UK
| | - Dimitrios Siassakos
- Obstetrics and Gynaecology, Southmead Hospital, Westbury on Trym, Bristol, BS10 5NB, UK.,University of Bristol, School of Social & Community Medicine, Bristol, UK
| |
Collapse
|
33
|
Miller ES, Minturn L, Linn R, Weese-Mayer DE, Ernst LM. Stillbirth evaluation: a stepwise assessment of placental pathology and autopsy. Am J Obstet Gynecol 2016; 214:115.e1-6. [PMID: 26319054 DOI: 10.1016/j.ajog.2015.08.049] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Revised: 07/20/2015] [Accepted: 08/19/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND The American Congress of Obstetricians and Gynecologists places special emphasis on autopsy as one of the most important tests for evaluation of stillbirth. Despite a recommendation of an autopsy, many families will decline the autopsy based on religious/cultural beliefs, fear of additional suffering for the child, or belief that no additional information will be obtained or of value. Further, many obstetric providers express a myriad of barriers limiting their recommendation for a perinatal autopsy despite their understanding of its value. Consequently, perinatal autopsy rates have been declining. Without the information provided by an autopsy, many women are left with unanswered questions regarding cause of death for their fetus and without clear management strategies to reduce the risk of stillbirth in future pregnancies. To avoid this scenario, it is imperative that clinicians are knowledgeable about the benefit of autopsy so they can provide clear information on its diagnostic utility and decrease potential barriers; in so doing the obstetrician can ensure that each family has the necessary information to make an informed decision. OBJECTIVE We sought to quantify the contribution of placental pathologic examination and autopsy in identifying a cause of stillbirth and to identify how often clinical management is modified due to each result. STUDY DESIGN This is a cohort study of all cases of stillbirth from 2009 through 2013 at a single tertiary care center. Records were reviewed in a stepwise manner: first the clinical history and laboratory results, then the placental pathologic evaluation, and finally the autopsy. At each step, a cause of death and the certainty of that etiology were coded. Clinical changes that would be recommended by information available at each step were also recorded. RESULTS Among the 144 cases of stillbirth examined, 104 (72%) underwent autopsy and these cases constitute the cohort of study. The clinical and laboratory information alone identified a cause of death in 35 (24%). After placental pathologic examination, 88 (61%) cases had a probable cause of death identified. The addition of autopsy resulted in 78 (74%) cases having an identifiable probable cause of death. Placental examination alone changed clinical management in 52 (36%) cases. Autopsy led to additional clinical management changes in 6 (6%) cases. CONCLUSION This stepwise assessment of the benefit of both placental pathological examination and autopsy in changing probable cause of death beyond traditional clinical history and laboratory results emphasizes the need to implement more comprehensive evaluation of all stillbirths. With the aim of providing a cause of stillbirth to the parents, and to prevent future stillbirths, it behooves health care professionals to understand the value of this more comprehensive approach and convey that information to the bereaved parents.
Collapse
|
34
|
Kandasamy Y, Kilcullen M, Watson D. Fetal autopsy and closing the gap. Aust N Z J Obstet Gynaecol 2015; 56:252-4. [DOI: 10.1111/ajo.12421] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 09/27/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Yogavijayan Kandasamy
- Department of Neonatology; The Townsville Hospital; Douglas Queensland Australia
- Mothers and Babies Research Centre; Hunter Medical Research Institute; John Hunter Hospital; The University of Newcastle; Newcastle New South Wales Australia
- College of Medicine and Dentistry; The James Cook University; Townsville Queensland Australia
| | - Meegan Kilcullen
- College of Health Care Sciences; The James Cook University; Townsville Queensland Australia
| | - David Watson
- College of Medicine and Dentistry; The James Cook University; Townsville Queensland Australia
- Department of Obstetrics and Gynaecology; The Townsville Hospital; Douglas Queensland Australia
| |
Collapse
|
35
|
Erickson LK. An Approach to the Examination of the Fetal Congenitally Malformed Heart at Autopsy. JOURNAL OF FETAL MEDICINE 2015. [DOI: 10.1007/s40556-015-0061-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
36
|
Abstract
The perinatal autopsy is an important tool in the investigation of fetal and neonatal death, and a complete understanding of its risks and benefits is necessary for providers of perinatal care. This review, from the perspective of a perinatal pathologist, reports the details of the autopsy procedure, its goals, its value to individual patients and the health care system in general, and its alternatives. Even with new emerging technologies, the conventional perinatal autopsy remains the gold standard for determining the cause of death and the final summary of all pathologic findings. Therefore, the information provided in this review can help providers properly convey information about perinatal autopsy to bereaved families.
Collapse
Affiliation(s)
- Linda M Ernst
- Department of Pathology, Northwestern University Feinberg School of Medicine, Olson Pavilion 2-461, 710 N. Fairbanks Court, Chicago, IL 60611.
| |
Collapse
|
37
|
Meaney S, Gallagher S, Lutomski JE, O'Donoghue K. Parental decision making around perinatal autopsy: a qualitative investigation. Health Expect 2014; 18:3160-71. [PMID: 25376775 DOI: 10.1111/hex.12305] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2014] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Decades of decline in uptake rates of perinatal autopsies has limited investigation into the causes and risk factors for stillbirth. AIMS This study aimed to qualitatively explore perinatal autopsy decision-making processes in parents who experienced antepartum and intrapartum stillbirths. MATERIAL AND METHODS A qualitative semi-structured interview format was utilized. The line of questioning centred on how parents came to decide on consenting or declining to have a perinatal autopsy undertaken. Interpretative phenomenological analysis was employed as the analytic strategy. Purposive sampling was used to recruit 10 parents who either consented or declined autopsy from a large tertiary maternity hospital in Cork Ireland, where there were 30 stillbirths in 2011. RESULTS Findings revealed four superordinate themes influencing parents' decision-making which varied with type of stillbirth experienced. Those parents who experienced antepartum stillbirths were more likely to consent; thus, knowing that the child was stillborn prior to delivery rather than on the day of delivery was associated with consent. In fact, these parents had more time for meaning-making; those consenting wanted to rule out self-blame and were fearful about future pregnancies. Parents who declined autopsy wanted to protect their infant from further harm. Interestingly, parents' knowledge and understanding of the autopsy itself were acquired primarily from public discourse. CONCLUSION Parents' decision-making regarding autopsy is profoundly affected by their emotional response to stillbirth; clinicians and other health professionals may play a key role, especially if they can address parental concerns regarding the invasiveness of the autopsy procedure.
Collapse
Affiliation(s)
- Sarah Meaney
- National Perinatal Epidemiology Centre, University College Cork, Cork, Ireland
| | - Stephen Gallagher
- Centre for Social Issues Research, Department of Psychology, University of Limerick, Limerick, Ireland
| | - Jennifer E Lutomski
- National Perinatal Epidemiology Centre, University College Cork, Cork, Ireland.,Nijmegen Centre for Evidence Based Practice, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Keelin O'Donoghue
- Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland
| |
Collapse
|
38
|
Rüegger CM, Bartsch C, Martinez RM, Ross S, Bolliger SA, Koller B, Held L, Bruder E, Bode PK, Caduff R, Frey B, Schäffer L, Bucher HU. Minimally invasive, imaging guided virtual autopsy compared to conventional autopsy in foetal, newborn and infant cases: study protocol for the paediatric virtual autopsy trial. BMC Pediatr 2014; 14:15. [PMID: 24438163 PMCID: PMC3897955 DOI: 10.1186/1471-2431-14-15] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Accepted: 01/17/2014] [Indexed: 11/23/2022] Open
Abstract
Background In light of declining autopsy rates around the world, post-mortem MR imaging is a promising alternative to conventional autopsy in the investigation of infant death. A major drawback of this non-invasive autopsy approach is the fact that histopathological and microbiological examination of the tissue is not possible. The objective of this prospective study is to compare the performance of minimally invasive, virtual autopsy, including CT-guided biopsy, with conventional autopsy procedures in a paediatric population. Methods/Design Foetuses, newborns and infants that are referred for autopsy at three different institutions associated with the University of Zurich will be eligible for recruitment. All bodies will be examined with a commercial CT and a 3 Tesla MRI scanner, masked to the results of conventional autopsy. After cross-sectional imaging, CT-guided tissue sampling will be performed by a multifunctional robotic system (Virtobot) allowing for automated post-mortem biopsies. Virtual autopsy results will be classified with regards to the likely final diagnosis and major pathological findings and compared to the results of conventional autopsy, which remains the diagnostic gold standard. Discussion There is an urgent need for the development of alternative post-mortem examination methods, not only as a counselling tool for families and as a quality control measure for clinical diagnosis and treatment but also as an instrument to advance medical knowledge and clinical practice. This interdisciplinary study will determine whether virtual autopsy will narrow the gap in information between non-invasive and traditional autopsy procedures. Trial Registration ClinicalTrials.gov: NCT01888380
Collapse
|
39
|
The feasibility of prospectively studying maternal cardiovascular changes from before conception. Hypertens Res 2013; 36:698-704. [DOI: 10.1038/hr.2013.24] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Revised: 01/09/2013] [Accepted: 01/14/2013] [Indexed: 11/08/2022]
|
40
|
Horey D, Flenady V, Heazell AEP, Khong TY. Interventions for supporting parents' decisions about autopsy after stillbirth. Cochrane Database Syst Rev 2013:CD009932. [PMID: 23450611 DOI: 10.1002/14651858.cd009932.pub2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Stillbirth remains one of the least understood areas of infant death and accurate data on the causes of stillbirth are the cornerstone of stillbirth prevention. An autopsy examination remains the gold standard post-mortem investigation for stillbirth. However, decisions about post-mortem investigations, particularly autopsy are difficult. The purpose of this review is to examine the effectiveness of methods to help parents who have experienced a stillbirth decide whether to have post-mortem investigations, including whether to have an autopsy performed. OBJECTIVES The primary objectives were a) to examine the effectiveness of interventions to support parents' decisions about autopsy consent after a stillbirth on outcomes for parents, and b) to determine autopsy rates. Secondary objectives were to identify issues related to the acceptability of any interventions to parents and the feasibility of their implementation. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (29 October 2012), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 10), MEDLINE (1966 to 24 July 2012) and EMBASE (1980 to 24 July 2012), Current Controlled Trials metaRegister (mRCT) (18 September 2012) and the WHO International Clinical Trials Registry Platform Search Portal (ICTRP) (18 September 2012). We also searched the websites of the Stillbirth and Neonatal Death Charity (SANDS) and International Stillbirth Alliance (ISA) (18 September 2012) and then subsequently searched the websites of all the ISA member organisations. SELECTION CRITERIA Randomised controlled trials (RCTs) of interventions designed specifically to support parents who have experienced a stillbirth make decisions about their options for post-mortem investigations including all investigations after stillbirth compared with usual care. DATA COLLECTION AND ANALYSIS Two review authors independently screened citations against the selection criteria. MAIN RESULTS No studies meeting the review inclusion criteria were identified. A search of 40 websites associated with supporting parents who experience stillbirth also found little reference to, or information about autopsy or other post-mortem examinations. AUTHORS' CONCLUSIONS Support for parents making decisions about autopsy or other post-mortem examinations after stillbirth must rely on the ad hoc knowledge and experience of those involved at the time.
Collapse
Affiliation(s)
- Dell Horey
- Faculty of Health Sciences, La Trobe University, Bundoora, Australia.
| | | | | | | |
Collapse
|
41
|
Horey D, Flenady V, Conway L, McLeod E, Yee Khong T. Decision influences and aftermath: parents, stillbirth and autopsy. Health Expect 2012; 17:534-44. [PMID: 22708659 DOI: 10.1111/j.1369-7625.2012.00782.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Stillbirth, among the most distressing experiences an adult may face, is also a time when parents must decide whether an autopsy or other post-mortem examinations will be performed on their infant. Autopsies can reveal information that might help explain stillbirth, yet little is known about how people make this difficult decision. OBJECTIVES This study examines the influences on decisions about autopsy after stillbirth among Australian parents. DESIGN The study involved secondary analysis of transcripts of three focus groups using qualitative content analysis. PARTICIPANTS AND SETTING Seventeen parents of 14 stillborn babies participated in consultations around the revision of a perinatal mortality audit guideline. RESULTS Parents shared the decision making. Four decision drivers were identified: parents' preparedness or readiness to make decisions; parental responsibility; concern for possible consequences of an autopsy and the role of health professionals. Each decision driver involved reasons both for and against autopsy. Two decision aftermath were also present: some parents who agreed to an autopsy were dissatisfied with the way the autopsy results were given to them and some parents who did not have an autopsy for their infant expressed some form of regret or uncertainty about the choice they made. CONCLUSIONS To make decisions about autopsy after stillbirth, parents need factual information about autopsy procedures, recognition that there might be fear of blame, an environment of trust, and health services and professionals prepared and skilled for difficult conversations.
Collapse
Affiliation(s)
- Dell Horey
- Research Fellow, Research Education and Development Unit, La Trobe University, Melbourne, Vic.Associate Professor, Mater Medical Research Institute, University of Queensland, Brisbane, QldState Coordinator, SANDS Queensland, Brisbane, QldFounder and Director, Stillbirth Foundation Australia, Sydney, NSWConsultant, SA Pathology at Women's and Children's Hospital, University of Adelaide, Adelaide, SAMember, Australian and New Zealand Stillbirth Alliance (ANZSA), Woolloongabba, Qld, Australia
| | | | | | | | | |
Collapse
|