Minimally invasive perinatal and pediatric autopsy with laparoscopically assisted tissue sampling: feasibility and experience of the MinImAL procedure

Abstract

Objective Less invasive autopsy techniques in cases of fetal or infant death have good acceptability among parents, but the published sampling adequacy in needle biopsy studies is generally poor. Minimally Invasive Autopsy with Laparoscopically assisted sampling (MinImAL) has the potential to increase the diagnostic yield of less invasive autopsy by improving the quality and quantity of tissue samples obtained, whilst permitting visualization, extraction and examination of internal organs through a small incision. The aim of this study was to present the findings of our experience with the MinImAL procedure in cases of fetal, neonatal and pediatric death. Methods This was a retrospective analysis of 103 prospectively recruited unselected cases of fetal, neonatal or pediatric death that underwent the MinImAL procedure at a tertiary referral center over a 5‐year period. Following preprocedure 1.5‐T whole‐body postmortem magnetic resonance imaging, MinImAL autopsy was performed. Procedure duration, sampling adequacy and cause of death were assessed. Chi‐square analysis was used to compare the ‘unexplained’ rate of intrauterine deaths in the cohort with that in a previously published cohort of > 1000 cases of intrauterine death examined by standard autopsy. Results MinImAL autopsy was performed successfully in 97.8% (91/93) of the cases undergoing a complete procedure. There was a satisfactory rate of adequate histological sampling in most major organs; heart (100%, 91 cases), lung (100%, 91 cases), kidney (100%, 91 cases), liver (96.7%, 88 cases), spleen (94.5%, 86 cases), adrenal glands (89.0%, 81 cases), pancreas (82.4%, 75 cases) and thymus (56.0%, 51 cases). Procedure duration was similar to that of standard autopsy in a previously published cohort of intrauterine deaths. The unexplained rate in stillbirths and intrauterine fetal deaths that underwent MinImAL autopsy was not significantly different from that following standard autopsy. Conclusions The MinImAL procedure provides good histological yield from major organs with minimal cosmetic damage and can be learned by an autopsy practitioner. The MinImAL procedure is an appropriate minimally invasive alternative for the investigation of perinatal and pediatric deaths in which consent to full autopsy is withheld, and may have applications in both high‐ and low/middle‐income settings. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.

Investigation of stillbirth causes in Suriname: application of the WHO ICD-PM tool to national-level hospital data

“…Determination of causes remains challenging due to the pathophysiological interaction between mother, foetus and placenta and multiple co-existing conditions that can contribute [31,32]. Previous studies have shown that diagnostic assessments, such as post-mortem autopsy or minimal invasive perinatal autopsy, reduced the percentage of unexplained deaths [32][33][34][35]. Global consensus on standardisation of necessary diagnostic assessments in stillbirths would not only improve classifications globally but also motivate healthcare providers, researchers and policymakers to reduce preventable stillbirths.…”

Postmortem microfocus computed tomography for noninvasive autopsies: experience in >250 human fetuses

“…Invasive examinations were performed in 29 of 236 fetuses (12.3%), which included a full conventional autopsy in 17 fetuses (58.6%), an MIA in 7 (24.1%) (this subset has also been reported in previous publications 20,21 ), and a limited autopsy in 5 (17.2%).…”

“…Original Research OBSTETRICS ajog.org were conducted through either ultrasound-guided 20 or laparoscopic-guided biopsy techniques. 21 In our department, a death classification system is not used routinely, although a narrative exploration of findings linked to clinical history is provided in the final autopsy report.…”

A pragmatic evidence-based approach to post-mortem perinatal imaging

“…Ultrasound-guided biopsies are more successful (76.1%) and can be performed via the umbilical vein mitigating incisions to the body [ 36 ]. Laparoscopically guided tissue sampling yields the highest success rates (> 80%) [ 37 ] but can be difficult to perform in small foetuses, and necessitates small incisions and more expensive equipment not commonly found in many mortuaries. It is important prior to conducting any tissue sampling that parental consent has been provided for this.…”