5








The postmortem investigation

 
     

Information is collected by CEMACH about whether a postmortem has been held or is being arranged. Postmortem reports are then obtained by the CEMACH regional offices in order to confirm the cause of death. Postmortem rates (per 100 cases) by region are displayed in Table 11.

Overall, the postmortem rate for all cases was 42.4%. This represents an increase since 2003, when only 39.0% of cases was a postmortem examination carried out. This slight increase is encouraging, given the longstanding decline in postmortem examinations seen in the 1990s and early 2000s.9 Regionally, the reported uptake of postmortem examination varied from 49.9% in the South West to only 27.2% in the North West.

In those cases where a postmortem examination was not performed, 62% of these were due to parents or guardians declining permission. A further 37% were not requested with the remaining 1% not being performed even after consent was obtained.

A postmortem examination is useful not only for ascertaining the correct cause of death of in utero losses and neonatal deaths which may lead to greater exploration of potential preventive measures but can also be useful to parents when planning future pregnancies.

There is a need to develop consistent and reliable pathological observations related to stillbirths to achieve standardisation nationally of postmortem reporting and interpretation. Progress here has stalled as a result of the extensive reduction in postmortem uptake that occurred in the 1990s. Rates fell from 58% in 1993 to 39% in 2003. It will be likely to take some time before public confidence returns and for improvements in recruitment, training and retention of specialist paediatric perinatal pathologists to take effect. However, it is of some reassurance that this fall in postmortem rates appears to be at least plateauing at 42% in 2004.