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PubMed1994

Are autopsy studies reliable in assessing gallstone prevalence in the community?

BACKGROUND: Autopsy studies have been used for many years to estimate gallstone prevalence in the population, although this has been questioned because of the risk of selection bias. METHODS: Gallstone prevalence measured by ultrasonographic screening of a random population was compared with gallstone prevalence assessed by routinely collected autopsy data in the same area during the same time period. To assess whether recording of gallstones detected in routinely performed autopsies was valid, a prospective investigation of gallstone prevalence in consecutive autopsies was performed. RESULTS: The age-standardized gallstone prevalences were 9.5 in the population and 9.2 in the autopsy study among males, whereas the corresponding figures were 16.1 and 15.9 among females. These figures were not significantly different. Gallstone prevalence in the prospective study was significantly higher than in the retrospective autopsy study (odds ratio [OR] = 1.54, 95% confidence interval [CI]: 1.08-2.19), suggesting inadequate recording of gallstones in routinely performed autopsies. The proportions of small stones were equal in the prospective autopsy study and the screening study, indicating that autopsy is not superior to ultrasonography in detecting gallstones. CONCLUSION: Routinely collected autopsy data may be a good estimate of gallstone prevalence in the community, but this could be coincidental and due to bias acting in opposite directions, with higher true prevalence balanced by inadequate detection of gallstones in routine autopsy studies.

Adult↗
PubMed1996

Medical students' attitudes toward the autopsy.

BACKGROUND: The autopsy is an educational experience that helps students correlate clinical findings with basic science issues. Because of the sensitive nature of the autopsy, students' attitudes should be considered prior to its design and implementation. METHOD: In 1992-1993, all 147 second-year students at the Medical College of Ohio completed a 26-item Likert questionnaire about their attitudes toward the autopsy. After participating in an elective autopsy experience, 26 students completed the same questionnaire plus 18 additional questions about the environment and behavior of the pathologist. Pre- and post-autopsy responses were factor analyzed using principal-components analysis with a varimax rotation. Student's t-tests were used to compare (1) the pre-autopsy factor scores of the elective participants and the rest of the class and (2) the pre- and post-autopsy scores of the participants. RESULTS: Factor analysis of the attitude questions identified seven factors. Comparison of the pre- and post-autopsy scores of the elective participants revealed statistically significant positive increases on four factors; three factors remained positive or neutral. CONCLUSION: It was concluded that the autopsy elective had a positive influence on the student's attitudes. In addition, the pathologist's behavior and the environment in which the autopsy occurred influenced the students. Twenty-two (85%) of the students indicated the autopsy should be mandatory for all students.

Adult↗
PubMed2002

Autopsies in trauma do not add to peer review or quality assurance.

OBJECTIVES: The literature supports the concept that autopsies are useful in uncovering missed injuries or undiagnosed conditions that contribute to death after injury, especially late deaths that take place in the intensive care unit. Review of autopsies are also used as part of the trauma quality assurance (QA) process, and autopsy rates are queried by the American College of Surgeons Committee on Trauma in their reviews. Our hypothesis was that autopsies add little useful clinical or diagnostic information compared with QA peer review analysis in a mature trauma program. METHODS: Autopsies for all mortalities at a Level I trauma center between January 1998 and October 1999 were reviewed. The autopsies were reviewed in a "blinded" fashion such that each review occurred before examination of the chart, the trauma registry, and the findings of the trauma QA peer review. Findings from all sources were compared and examined for Goldman type errors (I-IV). RESULTS: Two hundred sixty-three mortalities were identified, with 216 autopsies reviewed. One hundred two (39%) mortalities were considered dead on arrival to the trauma center by QA review, with no management errors identified (group 1) (Immediate Death group). Sixty-one patients survived more than 48 hours after injury (group 2). One hundred sixty-one (61%) patients were admitted to the hospital. Ninety-nine patients died within 48 hours (Early Death group) and 62 died between 2 and 143 days (Late Death group). There were no Goldman type I errors (major diagnostic discrepancies that might have influenced mortality) identified in either group. Autopsy data did uncover one potentially technical error in a death that was considered nonpreventable on peer review analysis. CONCLUSION: We conclude that autopsy information for either group appeared to add little useful information to the QA peer review of deaths in a mature trauma program. This was true even in cases where the final QA determination was held pending the results of the autopsy. Autopsy rates may not be a useful parameter in evaluating a trauma QA program.

Adult↗
PubMedDate not supplied

Evaluation of selection bias in an incident-based dementia autopsy case series.

Neuropathological (np) relative frequency estimates of dementia may be biased if the autopsied subjects are not representative of all dementia subjects within a target population. We identified characteristics that differed between autopsied and non-autopsied subjects from an incident-based dementia case series and compared autopsy-based estimates of the relative frequency of np diagnoses before and after adjusting for potential selection bias. Clinically demented subjects who were autopsied (n = 206), had died but were not autopsied (n = 271), were still alive (n = 71), or had dropped out of the study (n = 82) were included. Compared with non-autopsied subjects, autopsied subjects were more likely to be Caucasian, educated beyond high school, and married. They also tended to have a lower baseline Mini-Mental State Examination score and were more likely to have a clinical diagnosis of Alzheimer disease (AD) than non-autopsied subjects. Neuropathological AD with Lewy bodies (LB) had the largest crude relative frequency estimate at 38% of the autopsy sample, followed by 25% for AD with vascular lesions, 13% for pure AD, 13% for LB (with or without vascular lesions), and 8% for pure vascular pathologies. Adjustment for potential sources of selection bias had little effect on relative frequency estimates, suggesting that np diagnoses in the autopsied subjects provide reasonable dementia relative frequency estimates among all clinically demented cases in this series.

Aged↗
PubMed1988

Value of autopsy in internal medicine: a 1-year prospective study of hospital deaths.

In a university Department of Internal Medicine, we compared the clinical information, as written down immediately post mortem, with the demand for autopsy and with the autopsy findings during one complete year. Autopsies were performed in 143 of 306 consecutive deaths. In autopsied patients clinicians had recorded more diagnoses per patient, but with less certainty than in non-autopsied patients. Patients with a diagnosis of a solid tumour were autopsied less often, and patients with infections or gastrointestinal disease more often than the average patient. These findings indicate selection of cases for autopsy. In 41% of patients erroneous diagnoses were detected that might have influenced management of the patient. In 28% of patients autopsy offered no additional information about one or more diagnoses. Both the proportion of errors and the proportion of uninformative autopsies increased with decreasing clinical certainty about the diagnosis. We conclude that autopsy offers useful information in most cases, and that selection of cases for autopsy is probably not justified.

Adolescent↗
PubMed1993

Decline in autopsies for deaths attributed to cerebrovascular disease.

BACKGROUND AND PURPOSE: United States national autopsy rates have declined in recent years. In the present study, changes in autopsy rates for deaths due to stroke are examined and compared with changes in autopsy rates for all deaths. METHODS: National Center for Health Statistics data on United States national autopsy rates were examined for the years 1955, 1958, and 1972-1988. RESULTS: Since at least 1955, nonstroke deaths were more than twice as likely to be autopsied as deaths due to cerebrovascular disease. The annual autopsy frequency for all deaths, for deaths due to stroke, and for deaths due to each stroke subtype declined precipitously after 1972. Since 1982, less than 5 percent of deaths attributed to stroke have been documented by autopsy. Information obtained at autopsy was frequently ignored in the determination of cause of death on the death certificate. CONCLUSIONS: Careful consideration of the value of autopsy for education, research, and quality assurance is urgently needed. Unless the present problems in obtaining, processing, disseminating, and using autopsy data are adequately addressed, the autopsy rate will continue to decline.

Autopsy↗
PubMed2000

The declining autopsy rate and clinicians' attitudes.

The autopsy rate has been declining worldwide for decades. This study determined the overall and differential autopsy rates for the Royal Victoria Hospital, Belfast for the years 1997-1999 inclusive. Trends were examined by comparison with previously collected data for the years 1990, 1991 and 1993. Reasons for the decline in autopsy rates as perceived by hospital clinicians were assessed by means of a questionnaire. Over the last decade, there has been a steady decline in the overall autopsy rate from 30.4% in 1990 to 18.4% in 1999. This is due to a decrease in the hospital autopsy rate from 21.6% in 1990 to 7.9% in 1999. The coroner's autopsy rate has remained comparatively unchanged at around 11%. The decline in the overall and hospital autopsy rates involves all of the principal bedholding directorates, but is most dramatic in medicine, surgery and intensive care, where hospital autopsy rates are currently 7% or less. The main reasons for this decline as perceived by clinicians are difficulty in obtaining consent from relatives and advances in modern diagnostic techniques. The findings of this enquiry are in keeping with trends elsewhere, despite repeated studies which clearly demonstrate the continuing value of the autopsy in clinical practice. Recent publicity concerning the retention of organs can only have an adverse affect. Pathologists and clinicians who value the autopsy must become actively engaged in both public and medical education. Renewed emphasis must be placed on the importance of the autopsy in teaching, training and clinically relevant research, and as a means of medical audit.

Adult↗
PubMed1991

Use of the autopsy in Northern Ireland and its value in perioperative deaths.

A report on the pilot study of the Confidential Enquiry into Perioperative Deaths was published recently in the United Kingdom. The scheme was designed as a specialized form of clinical audit relating to perioperative patient care. Because the report placed little emphasis on autopsy, we have looked at all autopsied perioperative deaths, as defined by the enquiry, over a three-year period (1986-88) in a defined catchment area of Northern Ireland. Class I major discrepancies of diagnosis between clinical and postmortem records were found in 21% of 213 autopsied perioperative deaths. By definition, these represented instances in which an adverse impact on patient survival had resulted from the discrepancy. In an additional 29% of cases, there were Class II major discrepancies, which were discrepancies in the primary diagnosis not relevant to life-saving treatment. In 30% of cases there was a discrepancy in a secondary diagnosis, which might have affected the eventual prognosis, had the patient survived, but which was not related directly to the cause of death; these were termed Class III discrepancies. In 47% of cases, there were Class IV discrepant secondary diagnoses, which were 'incidental' findings and had no bearing on prognosis. To put these findings in context, the autopsy rate in Northern Ireland was 12% in 1987, with a higher rate (23%) in the two main teaching hospitals and a lower rate (8%) in all other hospitals. The rate of coroner's autopsies, 6%, is uniform throughout Northern Ireland. Coroner's autopsies are carried out mostly by the salaried staff of the State Pathologist's department. The observed differences in the rates of hospital autopsies reflect local deficiencies of pathologists in relation to the work load. In a series of consecutive autopsies carried out at one of the main teaching hospitals, the highest autopsy rate (68%) was found for paediatric patients, with rates of 29% for surgical and 23% for medical cases. The proportion of hospital autopsies carried out in perioperative surgical patients was the same as that for medical patients, reflecting the fact that no particular emphasis is placed on use of the autopsy as a form of clinical audit for the perioperative group.

Adolescent↗
PubMed1994

[Autopsies for general practitioners and for clinical specialists; analysis of indications].

OBJECTIVE: To evaluate the reasons for autopsies requested by general practitioners, compared with autopsies requested by clinicians. DESIGN: Retrospective descriptive comparative study. SETTING: Department of Pathology, Free University Hospital, Amsterdam; Medical Centre Alkmaar; Regional Laboratory Twente, Enschede and Regional Pathology Laboratory, Blaricum. MATERIAL AND METHOD: In a series of 303 autopsies requested by general practitioners, the reasons for the autopsy were divided into the following categories: sudden unexpected death, short fatal course of disease, intrauterine and perinatal death, evaluation of a protracted course of disease, non-natural death, and others. Results were compared with two series of 2961 and 1747 autopsies performed for clinicians in a university hospital and a non-university hospital, respectively. RESULTS: General practitioners requested autopsy mainly in cases of sudden unexpected death (48.2%) and short fatal courses of disease (16.5%). For the autopsies requested by clinicians in the university hospital these figures were 6.1% and 15.5%, respectively, in the non-university hospital 9.1% and 18.2%. Owing to the autopsies requested the percentage of cases with unknown or uncertain cause of death was reduced from 67.1% to 14.4%. CONCLUSIONS: General practitioners mainly request autopsy when important questions of themselves or of the bereaved need to be answered. Thresholds for autopsy, including financial ones, need to be eliminated to enable general practitioners to request autopsies.

Academic Medical Centers↗
PubMed1996

Forensic pathology in northern Norway. Requested medico-legal autopsies in the counties of Finnmark and Troms 1973-1992.

The aim of this study was to analyse medico-legal autopsy rates among Norwegian citizens who died in the two northernmost counties of Norway during the 20-year period 1973-1992. Medico-legal autopsy rate was defined as the number of medico-legal autopsies divided by the total number of deaths. The rates were calculated according to year of death, manner of death, sex, age, police district and county. The material included 1539 medico-legal autopsies. In the total 20-year period 37.9% (n = 1113) of the violent deaths and 1.2% (n = 426) of the natural deaths were subjected to medico-legal autopsy. The annual rates increased gradually up to 1987. In the last 5-year period 51.7% of the violent deaths and 2.1% of the natural deaths were subjected to medico-legal autopsy. Among violent deaths in this period the medico-legal autopsy rates were: suicides 65.7%, motor vehicle traffic accidents 58.3%, falls 8.6%, and other violent deaths 77.1%. Females dying after a fall and due to natural causes were significantly less frequently than males subjected to medico-legal autopsy. These two categories of death also revealed a significant decrease in autopsy rate with increasing age (age group 0-29, 30-59 and > or = 60 years) in each 5-year period. In cases of violent death the medico-legal autopsy rate according to police district varied from 24.1% to 88.9% in the last 5-year period. In conclusion, medico-legal autopsy rates depended on manner of death, sex, age and police district, besides changes in legislation.

Accidents, Traffic↗
PubMed2002

The role of the autopsy in medical malpractice cases, I: a review of 99 appeals court decisions.

CONTEXT: Fear that damaging information from autopsy may be introduced as evidence in lawsuits alleging medical malpractice is often cited as one factor contributing to the decline in autopsy rates. OBJECTIVE: To determine how autopsy information influences the outcome of medical malpractice litigation. DESIGN: We studied state court records in 99 cases of medical malpractice adjudicated from 1970 to the present to assess the role of information from autopsies in the outcomes. RESULTS: The 3 largest groups defined by cause of death at autopsy were acute pulmonary embolism, acute cardiovascular disease, and drug overdose/interaction. Findings for defendant physicians outnumbered medical negligence in the original trial proceedings by a 3:1 margin. The appellate courts affirmed 51 acquittals and 19 findings of negligence, and reversed the original trial court decision in 29 cases for technical reasons. We found no significant relationship between accuracy of clinical diagnosis (using the autopsy standard) and outcome of a suit charging medical negligence. Even when a major discrepancy existed between the autopsy diagnosis and the clinical diagnosis, and the unrecognized condition was deemed treatable, defendant physicians were usually exonerated. Moreover, major diagnostic discrepancies were relatively uncommon in suits in which a physician was found to be negligent. Conversely, in about 20% of cases, autopsy findings were helpful to defendant physicians. CONCLUSIONS: Our study confirms that a finding of medical negligence is based on standard-of-care issues rather than accuracy of clinical diagnosis. Autopsy findings may appear to be neutral or favorable to either the plaintiff or the defendant, but are typically not the crux of a successful legal argument for either side in a malpractice action. We conclude that fear of autopsy findings has no rational basis and is an important obstacle to uninhibited outcomes analysis.

Adult↗
PubMed2000

Autopsy consent practice at US teaching hospitals: results of a national survey.

BACKGROUND: Autopsy rates continue to fall despite the enduring benefit of the procedure to families and medical science, yet there are few data about the consent process itself. OBJECTIVE: To evaluate the current practice of obtaining autopsy consent, by assessing the consent forms currently in use, the knowledge and attitudes of chief residents on the procedure, and the expert opinion of pathologists in those institutions. DESIGN: Cross-sectional survey. SETTINGS AND PARTICIPANTS: One hundred twenty-seven US teaching hospitals. RESULTS: Of all autopsy consent forms we surveyed, 84.7% contained 7 of 10 elements recommended by the College of American Pathologists. Only 7.1% of institutions supplied educational materials for the physician, as recommended by the College of American Pathologists. Overall, 50.1% of chief residents reported deficiencies in their knowledge of the autopsy procedure. Correspondingly, greater than 74.5% felt that educational materials would be beneficial for physicians and the family. Finally, 93.3% of chief residents believed that a limited autopsy should be offered to families, while 68 (90%) of 76 pathologists at these institutions believed that limited autopsies are an unsatisfactory alternative to the complete procedure. CONCLUSIONS: Chief residents at US teaching hospitals reported substantial deficiencies in their knowledge about autopsy and desire more training on the consent process. Autopsy consent forms are often lacking information that might help physicians and families in making an educated choice about autopsy. Teaching institutions need to reevaluate the training for the autopsy consent practice.

Autopsy↗
PubMed2004

[Clinical autopsy: a useful tool in the emergency department of teaching hospitals].

BACKGROUND AND OBJECTIVE: We aimed to know the usefulness of clinical autopsy at the medical room of an emergency department in a teaching hospital. PATIENTS AND METHOD: Retrospective study of clinical autopsies performed in the emergency department of a teaching hospital between 1995 and 2000. We explored the correlation between clinical emergency and autopsy diagnosis. RESULTS: The number of deaths was 1,484 (0.9%) among 165,662 patients attended in the emergency medical room in the study period. Of 281 autopsies (18.9%), 227 (15.3%) were judicial. Only 54 clinical autopsies (3.6%) were included. Dyspnea and chest pain, the two more frequent guide symptoms, were in concordance with the two more prevalent initial clinical diagnoses: respiratory and cardiovascular diseases. 38.9% (21 cases) of autopsies agreed with the clinical diagnosis and 14.8% (8 cases) did not agree with it. 25.9% (14 cases) of autopsies were diagnostic since the clinical diagnosis, both initial and final, was unknown. Moreover, 14.8% (8 cases) autopsies were explanatory. Furthermore, 5.6% (3 cases) of autopsies were undetermined. With regard to the main cause of death, there were 9 (16.7%) cases of previously unknown neoplasms. CONCLUSIONS: The results of the present study confirm the need and usefulness of autopsy in patients dying in the medical room of emergency departments, as well as the crucial role of the clinico-pathological exercise in the definitive diagnosis of the postmortem examination.

Aged↗
PubMed1999

Value of perinatal autopsy.

OBJECTIVE: To determine how often a perinatal autopsy identified the cause of death, and how frequently this information changed recurrence risk estimates or altered parental counseling. METHODS: We reviewed all autopsies of fetal stillbirths and briefly viable neonates performed by one perinatal pathologist at the University of Alabama Hospital from 1992 to 1994. RESULTS: Four hundred sixteen fetal and early neonatal deaths occurred at our hospital from January 1, 1992, to June 1, 1994. Consent for an autopsy examination was granted for 139 of these (33%), and all autopsies were performed by a single perinatal pathologist. Abnormalities likely to be the cause of death were identified in 130 of 139 cases (94%). Ninety-one subjects did not have structural anomalies: In 14 cases autopsy revealed previously unsuspected pathology that altered parental counseling; in 68 cases autopsy findings were consistent with the clinical obstetrical diagnosis; and in nine cases the cause of death could not be identified. Forty-eight subjects were anomalous. Thirty-seven of these (79%) had been evaluated by antenatal ultrasonography, and autopsy identified additional abnormalities in 51% (19 of 37). In the 11 deaths evaluated neonatally, a previously unsuspected diagnosis likely to be the cause of death was identified in three. Overall, autopsy findings changed recurrence risk estimates and/or parental counseling in 36 of 139 cases (26%). CONCLUSION: The cause of fetal or perinatal death was determined by autopsy in 94% of cases in our series. Counseling and recurrence risk estimates were altered by autopsy findings in 26%.

Alabama↗
PubMed2003

Concordance between premortem and postmortem diagnosis in the autopsy: results of a 10-year study in a tertiary care center.

We describe the concordance between clinical diagnoses and autopsy findings in a tertiary care center. Clinical autopsy is a useful tool for the evaluation of accuracy of the clinical diagnoses. However, autopsy rates have declined around the world recently. We randomly evaluated 500 of 2,211 autopsies performed in the department of pathology of a tertiary care hospital during a 10-year period. We computed the sensitivity, specificity, predictive values, and concordance scores between premortem and postmortem diagnoses. The autopsy diagnoses were used as the "gold standard." Four-hundred twenty-two (84.4%) of the autopsies met inclusion criteria. Diseases of the respiratory tract were diagnosed in 44.1% (186) of all autopsy reports reviewed. The higher sensitivity for diagnosis was observed in congenital anomalies (87.5%), while the higher specificity was observed in diagnosis of complications of pregnancy, childbirth, and the puerperium (98.98%). The higher concordance between premortem and postmortem diagnosis was observed with the diagnoses of neoplasms (kappa = 0.76), and for the group of complications of pregnancy, childbirth, and the puerperium (kappa = 0.76). A clinical diagnosis successfully addressed the cause of death in 40% of the cases Low values for concordance between autopsy reports and clinical diagnoses were present in most of the autopsies reports reviewed. We encourage physicians to continue considering the autopsy as an important tool that extends our understanding of diseases.

Adolescent↗
PubMed2001

Malignant neoplasms: discordance between clinical diagnoses and autopsy findings in 3,118 cases.

BACKGROUND: During the past few decades, hospital autopsy rates have steadily declined throughout the Western world. This decline is mainly attributed to the introduction of advanced diagnostic techniques. Despite technological developments, discrepancy rates between clinical diagnoses and autopsy findings remain high. Few studies have addressed discrepancy rates exclusively with regard to malignant neoplasms. In the present study, we reviewed the records of 3,118 autopsies performed at Mayo Clinic during a 6-year period (1994-1999) and identified clinically undiagnosed malignancies found at autopsy and clinically diagnosed cancers not confirmed at postmortem examination. MATERIALS AND METHODS: Autopsy protocols, provisional and final anatomic diagnoses, and data from the Mayo Autopsy Pathology Quality Assurance program were reviewed in an attempt to identify discrepancies between clinical diagnoses and autopsy findings regarding malignant neoplasms. RESULTS: In 3,118 autopsies performed at Mayo Clinic between 1994 and 1999, a malignant tumor was identified in 768 cases (25%). In 128 of 3,118 cases (4.1%), the malignancy was not diagnosed clinically. In 14 of 3,118 cases (0.45%), autopsy failed to confirm a clinically diagnosed cancer. A review of the literature is presented. CONCLUSIONS: Autopsy remains an effective tool for the confirmation and refutation of clinical diagnostic findings regarding malignant neoplasms.

Autopsy↗
PubMed1994

Verbal autopsies for adult deaths: issues in their development and validation.

BACKGROUND: The verbal autopsy appears to be an attractive technique for the assessment of causes of adult death in settings where the proportion of people who die while under medical care is low. Verbal autopsies have been used extensively to assess causes of childhood deaths. The existing experience in verbal autopsies for adult deaths is limited mainly to maternal deaths. This paper aims to highlight the critical issues in verbal autopsies to assess causes of adult death which need further research. METHODS: This paper reviews the methods of verbal autopsy used in 35 published studies and discusses issues in the development of verbal autopsies, including mortality classification, design of questionnaires, interviewers, respondents, recall periods, procedures for deriving a diagnosis and the recording of single versus multiple causes of death. It also discusses issues in the validation of verbal autopsies, including the choice of reference diagnosis and the required sample size. RESULTS: The methodological approaches used in verbal autopsy studies have varied widely. Very few studies of the validity of verbal autopsies have been conducted. In these studies, the reported sensitivity and specificity varied widely between different causes of death and between studies. CONCLUSIONS: The information available is inadequate to draw firm conclusions on preferred methodological approaches for verbal autopsies for adult deaths. Before these tools are used more widely for adult deaths, further research is required to compare alternative methods and to evaluate the validity of this tool in a range of settings.

Adolescent↗
PubMed2006

Foetal and neonatal autopsy rates and use of tissue for research: the influence of 'organ retention' controversy and new consent process.

AIM: To examine whether the 'organ retention' controversy and new autopsy consent process had any effect on foetal and neonatal autopsy rates and on permitting the use of tissue for scientific research and education. METHODS: An audit of perinatal autopsy rates in a tertiary hospital prior to (1999-2001) and subsequent to the 'organ retention' controversy (2001-2002), and the introduction of a new consenting process (2002-2004). Rates were compared also with those a decade earlier (1990-1993). RESULTS: Overall autopsy rates have been falling significantly between the three study periods (1999-2001 71.7%; 2001-2002 61.5%; 2003-2004 50.5%). Autopsy rates have fallen significantly between 1990-1993 and 1999-2001 (P<0.00005) and between 1990-1993 and 1999-2004 (P<0.0000001). The autopsy rates for stillbirths and neonatal deaths have fallen significantly further since the 'organ retention' controversy but not significantly so following the new consenting process. Significantly fewer autopsies are performed on foetuses less than 20 weeks gestation in recent years than a decade ago (P<0.0000001). There were more external or limited autopsies in later years (P=0.015). Permission for the use of tissue for education and research is less frequent following the 'organ retention' controversy and particularly following the introduction of the new consenting process. CONCLUSION: Perinatal autopsy rates have fallen over the past 10 years. Fewer autopsies are being performed following the 'organ retention' controversy and use of tissue for research and education is permitted even less frequently following the introduction of the new consenting process.

Autopsy↗