Postmortem examination of human fetuses: comparison of two‐dimensional ultrasound with invasive autopsy

Kang, Xin; Shelmerdine, Susan C.; Hurtado, Ivan; Bevilacqua, Elisa; Hutchinson, J. Ciaran; Mandalia, Uday; Segers, Valérie; Sanchez, Teresa Cos; Cannie, Mieke; Carlin, Andrew; Sebire, Neil J.; Arthurs, Owen J.; Jani, Jacques

doi:10.1002/uog.18828

Cited by 23 publications

(54 citation statements)

References 24 publications

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“…On the basis of study title and abstract, 5999 articles were excluded and 18 articles were retrieved in full text. After review of the full text, four studies were eventually included in the systematic review 17–20. A PRISMA flowchart is shown in figure 1.…”

Section: Resultsmentioning

confidence: 99%

“…Our patient and study characteristics are provided in tables 1 and 2. All four articles related to PMUS for perinatal deaths 17–20. In all studies, parental consent was given for the ultrasound imaging.…”

Section: Resultsmentioning

confidence: 99%

“…The majority of studies (3/4, 75%) were prospective in design and conducted in a single centre (3/4, 75%). Two studies originated from France,18 19 one study originated from Belgium20 and one was a multicentre study involving patients from two institutions, one in the UK and one in Belgium 17. The timeframe for data collection ranged between 1 and 4 years.…”

Section: Resultsmentioning

confidence: 99%

“…A single operator performed all PMUS studies in almost all centres, except for one centre (based in Belgium) for the study by Kang et al ,17 where multiple operators performed the ultrasound scanning. For all cases, the ultrasound was performed prior to autopsy (therefore without knowledge of the reference test results).…”

Section: Resultsmentioning

confidence: 99%

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Diagnostic accuracy of perinatal post-mortem ultrasound (PMUS): a systematic review

Shelmerdine

Langan²,

Sebire

et al. 2019

bmjpo

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ObjectiveUltrasound is ubiquitous in live paediatric imaging; however, its usage in post-mortem setting is less established. This systematic review aims to evaluate the diagnostic accuracy of paediatric post-mortem ultrasound (PMUS).DesignMEDLINE, Embase and Cochrane Library databases were queried for studies published between 1998 and 2018 assessing PMUS diagnostic accuracy rates in children<18 years old, using autopsy as reference standard. Risk of bias was assessed using Quality Assessment of Diagnostic Accuracy Studies 2. A bivariate random-effects model was used to obtain combined mean estimates of sensitivity and specificity for different body systems.ResultsFour studies were included, all relating to ultrasound for perinatal deaths. The mean diagnostic sensitivity and specificity for neurological abnormalities were 84.3% (95% CI: 70.8% to 92.2%) and 96.7% (95% CI: 86.5% to 99.3%); for cardiothoracic abnormalities 52.1% (95% CI: 27.6% to 75.5%,) and 96.6% (95% CI: 86.8% to 99.2%); and for abdominal abnormalities 78.4% (95% CI: 61.0% to 89.4%) and 97.3% (95% CI: 88.9% to 99.4%). Combining all body systems, the mean sensitivity and specificity were 73.3% (95% CI: 59.9% to 83.5%) and 96.6% (95% CI: 92.6% to 98.4%).ConclusionsPMUS demonstrates a reasonable diagnostic accuracy, particularly for abdominal and neurological abnormalities, although cardiac anomalies were less readily identified.Trial registration numberCRD42018106968.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

Diagnostic accuracy of perinatal post-mortem ultrasound (PMUS): a systematic review

Shelmerdine

Langan²,

Sebire

et al. 2019

bmjpo

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“…Therefore, non‐invasive postmortem fetal investigations using ultrasound, magnetic resonance imaging (MRI), and minimal invasive endoscopy or biopsy have been suggested as replacements or complements to the conventional autopsy …”

Section: Introductionmentioning

confidence: 99%

Postmortem magnetic resonance imaging vs autopsy of second trimester fetuses terminated due to anomalies

Hellkvist

Wikström

Mulic‐Lutvica

et al. 2019

Acta Obstet Gynecol Scand

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Introduction Our aim was to investigate the accuracy of postmortem fetal magnetic resonance imaging (MRI) compared with fetal autopsy in second trimester pregnancies terminated due to fetal anomalies. A secondary aim was to compare the MRI evaluations of two senior radiologists. Material and methods This was a prospective study including 34 fetuses from pregnancies terminated in the second trimester due to fetal anomalies. All women accepted a postmortem MRI and an autopsy of the fetus. Two senior radiologists performed independent evaluations of the MRI images. A senior pathologist performed the fetal autopsies. The degree of concordance between the MRI evaluations and the autopsy reports was estimated as well as the consensus between the radiologists. Results Thirty‐four fetuses were evaluated. Sixteen cases were associated with the central nervous system (CNS), five were musculoskeletal, one cardiovascular, one was associated with the urinary tract, and 11 cases had miscellaneous anomalies such as chromosomal aberrations, infections and syndromes. In the 16 cases related to the CNS, both radiologists reported all or some, including the most clinically significant anomalies in 15 (94%; CI 70%‐100%) cases. In the 18 non‐CNS cases, both radiologists reported all or some, including the most clinically significant anomalies in six (33%; CI 5%‐85%) cases. In 21 cases (62%; CI 44%‐78%), both radiologists held opinions that were consistent with the autopsy reports. The degree of agreement between the radiologists was high, with a Cohen's Kappa of 0.87. Conclusions Postmortem fetal MRI can replace autopsy for second trimester fetuses with CNS anomalies. For non‐CNS anomalies, the concordance is lower but postmortem MRI can still be of value when autopsy is not an option.

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Latest developments in post‐mortem foetal imaging

et al. 2019

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A sustained decline in parental consent rates for perinatal autopsies has driven the development of less‐invasive methods for death investigation. A wide variety of imaging modalities have been developed for this purpose and include post‐mortem whole body magnetic resonance imaging (MRI), ultrasound, computed tomography (CT) and micro‐focus CT techniques. These are also vital for “minimally invasive” methods, which include potential for tissue sampling, such as image guidance for targeted biopsies and laparoscopic‐assisted techniques. In this article, we address the range of imaging techniques currently in clinical practice and those under development. Significant advances in high‐field MRI and micro‐focus CT imaging show particular promise for smaller and earlier gestation foetuses. We also review how MRI biomarkers such as diffusion‐weighted imaging and organ volumetric analysis may aid diagnosis and image interpretation in the absence of autopsy data. Three‐dimensional printing and augmented reality may help make imaging findings more accessible to parents, colleagues and trainees.

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Postmortem examination of human fetuses: comparison of two‐dimensional ultrasound with invasive autopsy

Cited by 23 publications

References 24 publications

Diagnostic accuracy of perinatal post-mortem ultrasound (PMUS): a systematic review

Diagnostic accuracy of perinatal post-mortem ultrasound (PMUS): a systematic review

Postmortem magnetic resonance imaging vs autopsy of second trimester fetuses terminated due to anomalies

Latest developments in post‐mortem foetal imaging

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