At Least an Infantogram if not Perinatal Autopsy

Abstract

To study the feasibility and value of postmortem fetal infantogram (X-ray film) in pregnancies terminated for prenatally diagnosed fetal congenital malformations and stillborn fetuses with congenital anomalies. Forty-two fetuses were diagnosed antenatally by ultrasonography to have fetal congenital malformation, 36 couples opted for medical termination of pregnancy (MTP) and intrauterine death (IUD) occurred in six cases. Informed written consent for autopsy including infantogram was given by 41 couples, one couple permitted only radiographs. On infantogram, the antenatal ultrasound diagnoses were confirmed in all the cases of central nervous system anomalies, but were not useful for genitourinary anomalies or cardiac anomalies. In five cases of antenatally suspected skeletal anomalies, radiographs changed the diagnosis of thanatophoric dwarf to osteogenesis imperfecta type llC in one case and achondrogenesis type 1B in another case. Infantogram made the syndromic diagnosis in three cases-sirenomelia, Roberts syndrome and caudal regression syndrome. Congenital diaphragmatic hernia was diagnosed at infantogram in a case missed on ultrasound. In three cases of nonimmune hydrops, X-ray films correlated with ultrasound findings, but could not find the cause. If autopsy, the 'goal standard' test is refused or cannot be done, at least an infantogram should routinely be done in pregnancies terminated for prenatally diagnosed fetal congenital malformations and stillborn fetuses with congenital anomalies, as it is noninvasive, easily available and consent given. It may change the diagnosis and counseling for future pregnancies, hence very useful in perinatal medicine.

Fetal Dysmorphology

“…The obstetrician needs to be familiar with fetal anomalies and their associations and also be informed of the value of fetal autopsy to make a final diagnosis for pregnancies that are discontinued [7]. Options of fetal radiographs with external examination in skeletal anomalies [8], fetal photographs [9], and newer techniques of minimally-invasive autopsy [10] should also be considered in specific circumstances.…”

Untitled

“…The issue contains six articles covering how to perform a fetal autopsy [2], gross examination of the placenta [3], fetal thrombotic vasculopathy [4], placental mesenchymal dysplasia [5], examination of congenitally malformed heart [6], nonmmune hydrops [7] and fetal dysmorphology [8]. Other articles previously published on fetal autopsy are-''At least and infantogram'' [9], and its usefulness in limb anomalies [10]. I urge all the members to read through these articles, as each of them is a gem, which will help them improve their knowledge of fetal medicine.…”

Advancing Horizons in Fetal Medicine

“…We had articles emphasizing the value of obtaining at least a radiograph of the skeleton after fetal demise [16,17], how it aids in providing a specific diagnosis of fetal skeletal dysplasias, and use of autopsy to find the etiology of fetal limb anomalies [18]. Fetal autopsies are still the gold standard in the diagnosis of fetal anomalies.…”