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Development of the minimally invasive paediatric & perinatal autopsy

Hutchinson, John Ciaran; (2019) Development of the minimally invasive paediatric & perinatal autopsy. Doctoral thesis (Ph.D), UCL (University College London). Green open access

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Abstract

Introduction Perinatal autopsy contributes useful clinical information to patient management in approximately 40% of cases but remains poorly accepted due to parental concerns regarding disfigurement. Post-mortem imaging is an alternative, but 1.5 T MRI lacks resolution below 18 gestational weeks. Additionally, the Royal College of Pathologists autopsy guidelines recommend extensive tissue sampling as part of the investigation of fetal loss, which imaging alone cannot provide. Possible mitigating strategies include micro-CT for phenotyping small fetuses and laparoscopic techniques to obtain tissue samples. Interrogation of the evidence base for tissue sampling in different clinical scenarios is necessary to develop evidence-based practice and recommendations. Methods Minimally Invasive Autopsy with Laparoscopy (MinImAL) was performed in 103 cases. Micro-CT was optimised in extracted organs and the diagnostic accuracy evaluated in 20 fetuses. The Great Ormond Street Autopsy Database was retrospectively interrogated to investigate the yield of internal examination and visceral histology to the cause of death in 5,311 cases. Results MinImAL examination is reliable (97.8% successfully completed, 91/93) with good tissue sampling success rates (100% in lung, kidney, heart). Micro-CT offers an accurate method of scanning small fetuses (97.5% agreement with autopsy, 95% CI, 96.6-98.4) with fewer non-diagnostic indices than standard autopsy in < 14 weeks gestation (22/440 vs 48/348 respectively; p<0.001). Histology of macroscopically normal viscera is valuable in the investigation of infant and childhood deaths. However, it provides almost no useful information relevant to cause of death or main diagnosis (<1%) in fetal cases. Conclusions MinImAL examination offers a reliable method of internal examination and tissue sampling, which may be acceptable when standard autopsy is declined. Micro-CT provides an accurate, non-invasive method for phenotyping early gestation fetal anatomy. Histological sampling of macroscopically normal visceral organs is valuable when investigating infant or child deaths but of limited value in fetal loss and hence should not be routinely performed.

Type: Thesis (Doctoral)
Qualification: Ph.D
Title: Development of the minimally invasive paediatric & perinatal autopsy
Event: UCL (University College London)
Open access status: An open access version is available from UCL Discovery
Language: English
Additional information: Copyright © The Author 2019. Original content in this thesis is licensed under the terms of the Creative Commons Attribution 4.0 International (CC BY 4.0) Licence (https://creativecommons.org/licenses/by/4.0/). Any third-party copyright material present remains the property of its respective owner(s) and is licensed under its existing terms. Access may initially be restricted at the author’s request.
Keywords: Autopsy, virtopsy, virtual autopsy, perinatal pathology, pathology, histology, stillbirth, sudden unexpected death in infancy, sudden unexpected death in childhood, termination of pregnancy, laparoscopic autopsy, micro-CT, microfocus computed tomography
UCL classification: UCL
UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL GOS Institute of Child Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL GOS Institute of Child Health > Developmental Neurosciences Dept
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL GOS Institute of Child Health > Population, Policy and Practice Dept
URI: https://discovery.ucl.ac.uk/id/eprint/10087041
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