ABSTRACT

Objectives: High perinatal autopsy rates are necessary for institutional management protocols and national policy-making. This study reviews perinatal autopsy rates and factors affecting these rates at the University Hospital of the West Indies.

Method: All perinatal deaths (stillborn infants ≥ 24 weeks gestation or 500 g; early neonatal deaths ie 0–7 days old) at the University Hospital of the West Indies, between January 2002 and December 2008, were reviewed retrospectively, using the annual perinatal audit records. The annual autopsy rates were calculated and the reasons why autopsies were not done examined.

Results: The average stillbirth (SB) autopsy rate was 59.6% (range 51.9 – 76.7%), while that for early neonatal deaths (ENDs) was 47.9% (range 34.4 – 63.2), with an overall average perinatal autopsy rate of 54.0% (range 42.2 – 62.2). Autopsies were requested in 79.3% and 51.7% of SBs and ENDs, respectively.
Of those requested, 81.7% were done (75.2% stillbirths; 92.5% ENDs). In the ENDs, failure to request an autopsy was predominantly noted in premature infants weighing < 1000 g (75.2% of those not requested). In stillbirths, the reasons for failure to request were largely unknown with failure to gain permission accounting for only 20.3% of these cases.

Conclusions: The average annual perinatal autopsy rate at the University Hospital of the West Indies between 2002 and 2008 was 54.0%. This is below the internationally recommended rate of 75%. Failure
to request an autopsy was the most significant factor contributing to this. The reasons for this are not entirely clear and require further study.