4 years ago

Postmortem examination of human fetuses: a comparison of 2-dimensional ultrasound with invasive autopsy

Jacques C. Jani, Mieke M. Cannie, Teresa Cos Sanchez, Elisa Bevilacqua, Uday Mandalia, Andrew Carlin, Ciaran Hutchinson, Susan C. Shelmerdine, Valerie Segers, Owen J. Arthurs, Neil J. Sebire, Ivan Hurtado, Xin Kang
Objective To compare the diagnostic usefulness of postmortem ultrasound with invasive autopsy in fetuses at different gestational ages. Methods We performed postmortem 2-dimensional ultrasound on 163 fetuses at 13-42 weeks gestation, blinded to clinical details. Logistic regression analysis was used to investigate the effect on non-diagnostic results of gestational age during postmortem ultrasound, presence of maceration, and cause of death. In 123 cases where invasive autopsy was available, the diagnostic accuracy of ultrasound in detecting major organ abnormalities was evaluated, using invasive autopsy as a gold standard. Results For the fetal brain, a non-diagnostic result was found in 17 (39.5%) of 43 fetuses with maceration and was significantly more common as compared to fetuses without maceration (24 [20.0%] of 120 fetuses [p=0.013]). For the fetal thorax, a non-diagnostic result was found in 15 (34.1%) of 44 fetuses at <20 weeks of gestation and in 13 (10.9%) of 119 fetuses at ≥20 weeks (p<0.001). For the heart and abdominal organs no association was demonstrated with the tested variables. For fetuses <20 weeks, specificity was 83.3% for brain anomalies, 68.6% for the thorax, and 77.4% for the heart. For fetuses ≥20 weeks, sensitivity and specificity were, respectively, 61.9% and 74.2% for the brain, 29.5% and 87.0% for the thorax, and 57.1% and 76.9% for the heart. Sensitivity was 60.7% and specificity 75.8% for fetal abdominal organs, mainly the kidneys, irrespective of gestational age. Conclusion Although maceration may lead to failure in some cases, postmortem ultrasound reaches diagnostically acceptable levels for brain and abdominal organs, compared with conventional autopsy. It may therefore play a role as a first-line examination before other virtual autopsy techniques are indicated.

Publisher URL: http://onlinelibrary.wiley.com/resolve/doi

DOI: 10.1002/uog.18828

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