Pathologist Effort in the Performance of Fetal, Perinatal, and Pediatric Autopsies: A Survey of Practice

Abstract

Context.—Autopsy is an important tool for quality assurance and improving patient care. Fetal, perinatal, and pediatric autopsies have the additional benefit of identifying conditions that may have increased risk of recurrence. In contrast to adult autopsies, special collections and testing are frequently used. Pathologist effort in fetal, perinatal, and pediatric autopsy has not been well documented. Objective.—To prospectively quantify pathologist time required to complete fetal, perinatal, and pediatric autopsies, and to gather information on special studies and whether or not a cause of death was identified. Design.—The Society for Pediatric Pathology Practice Committee disseminated a survey to pathologists to complete for each autopsy performed. Surveys recorded age/gestation, time spent on chart review, prosection, and microscopy, special testing performed, time spent on a discussion or presentation of findings, and whether a cause of death was found. Results.—We report results of 351 surveys. Pathologist effort in fetal cases was, on average, 5.9 hours; in perinatal cases, 9.8 hours; and in pediatric cases, 15.4 hours. Reflecting complexity, a total of 603 collections for ancillary studies were performed, most commonly karyotype, frozen tissue, and microbiology cultures. A cause of death was identified in 295 of 351 cases (84%). Most cases were presented at conferences. Conclusions.—Fetal, perinatal, and pediatric autopsies are time intensive and frequently complex. They have high clinical value, guiding risk assessment and reproductive decision-making by families. Understanding the time contribution by pathologists allows departments and hospitals to predict staffing.