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Pregnancy Loss and Infant Death Alliance Position
Statement, April 7, 2006:
When bereaved parents hold their baby’s body for any
length of time after death,
there is little or no impact on postmortem pathology studies
Charles Corr
Christy Torkildson
George Mark Children's House
San Leandro, CA 94578 |
BACKGROUND
Many parents benefit from repeated and extended opportunities to have close
contact with their deceased baby’s body, including touching, examining,
holding, cuddling, and kissing. For parents who want to have close and
extended contact with their baby, this nurturing experience affirms their
baby’s existence and importance, validates their role as parents to this
child, offers meaningful opportunities to express their love and devotion,
and cultivates treasured keepsakes and memories. This experience can also
help parents process the traumatic events surrounding their baby’s death and
experience a more gradual goodbye, both of which are productive components
of healthy grieving.
Parents also benefit from witnessing others gently touching and holding
their baby. The tender and reverent presence of others honors their baby,
and offers opportunities for supportive sharing of memories over the
normally lengthy grieving process.
Finally, parents benefit from having their cultural and spiritual needs
respected. In order to honor the parents’ preferences around the care of
their baby’s body after death, health care practitioners should ask each
family to explain their traditions and beliefs.
SUMMARY
When parents hold their baby’s body for any length of time after death, the
impact on postmortem pathology studies is minimal to nonexistent. In most
cases, etiologic evaluations can be delayed for hours or a day without
significant consequence on their being informative. In specific cases, some
examinations will be of greater value if performed within 24 hours after
death, and the pathologist should be contacted early to give advice.
Especially when early autopsy is indicated or required, the parents benefit
from meeting the pathologist who shall perform the autopsy.
After delivery and until the mother is discharged, the baby’s body can stay
in the room with the parents as much as they desire. When the baby is not
with the parents, refrigeration is advised in order to maintain the
integrity of the skin and to reduce the normal (though minor) proliferation
of any pathogens that were present at the time of death. The baby’s body can
be placed in a warming unit or wrapped in a warm blanket prior to being held
by the parents. For many parents, the benefits of extended and repeated
opportunities to spend time with their baby’s body far outweigh the benefits
of an expedited autopsy.
FACTS TO KEEP IN MIND
When parents hold their baby’s body for any length of time after death, this
has minimal impact on postmortem pathology studies.
Most etiologic evaluations can be delayed for hours without significant
consequence on their being informative, including radiographs, postmortem
assessment, and clinical examination, or maternal examinations such as
Kleihaur-Betke testing.
Delays can affect microscopic examination of tissues, but rarely are
microscopic studies of tissues from the baby crucial in identifying a cause
of death, and these studies are not significantly impeded by delaying
examination.
Even though successful growth of cells from the deceased body’s tissues is
affected by delays in obtaining and processing samples, successful cultures
can often be obtained even if sampling is delayed for 24 hours after death.
Cellular growth for chromosome studies of samples from the baby's body will
be more likely to be successful if cells are obtained within a few hours,
but genetic and metabolic skin samples can be obtained by the pathologist
quickly and unobtrusively, so that parents can spend as much time as they
want with their baby’s body before and after the procedure.
When obtaining tissue samples for cytogenetic evaluation after an
intrauterine death, the most crucial samples are placental ones. These
should be obtained as soon as possible after delivery, and most often, the
placental samples will be sufficient.
After an intrauterine death several or more days before delivery, postponing
autopsy for another day or more will not affect the results.
As technology progresses, current cytogenetic methods that require growth of
tissues are being supplanted, in whole or part, by molecular methods that
don’t require cellular growth (fluorescent in situ hybridization, microarray
comparative genomic hybridization, etc.) and delays will not affect
postmortem evaluation.
GUIDELINES
Delaying autopsy allows parents to spend meaningful and significant blocks
of time with their baby after death, and the impact on postmortem pathology
studies is minimal to nonexistent. When parents are able to have extended
and repeated opportunities to spend time with their baby’s body, the
psychosocial and emotional benefits to them can significantly outweigh the
benefits of prompt postmortem evaluation.
After delivery and until the mother is discharged, the baby’s body can stay
in the room with the parents as much as they desire. When the baby is not
with the parents, refrigeration is advised in order to maintain the
integrity of the skin and to reduce the normal, though minor, proliferation
of any pathogens that were present at the time of death. (Pathogen
proliferation poses an insignificant risk to the parents.) The baby’s body
can be placed in a warming unit or wrapped in a warm blanket prior to being
held by the parents.
When autopsy is indicated or required, contact the pathologist to request
advice on whether there are some examinations that will be of greater value
if performed within 24 hours after death. Also, parents benefit from meeting
the pathologist who shall perform the autopsy. Making personal contact
enables the pathologist to reassure the parents that she or he will take
good care of their baby, and this contact can increase autopsy rates.
Especially when samples need to be collected within 24 hours, the
pathologist can give the parents realistic and reassuring information about
what the autopsy consists of, and what the baby will look like when he or
she is returned to the parents.
References
British Columbia Reproductive Care Program. Perinatal Mortality Guideline 5:
Investigation and Assessment of Stillbirths. May, 2000
http://www.rcp.gov.bc.ca/guidelines/Master%5B1%5D.PM5.InvestAssesStillbirths.May2000.pdf
Keeling J, ed. Fetal and neonatal pathology. London: Springer, 2001
Royal College of Obstetricians and Gynaecologists and Royal College of
Pathologists. Fetal and Perinatal Pathology: Report of a Joint Working
Party. London: RCOG Press, 2001. http://www.rcp.gov.bc.ca/guidelines/Master%5B1%5D.PM5.InvestAssesStillbirths.May2000.pdf
Wigglesworth JS, Singer DB, eds. Textbook of fetal and perinatal pathology.
Boston: BlackwellScience, 1998.
Wisconsin Stillbirth Service Project (WiSSP) Most Often Asked Questions
about Stillbirth Evaluation
http://www.wisc.edu/wissp/commonly.htm
Wright C, Lee REJ. Investigating perinatal death: a review of the options
when autopsy consent is refused. Archives of Disease in Childhood Fetal and
Neonatal Edition 2004;89:F285.
http://fn.bmjjournals.com/cgi/content/full/89/4/F285
Additional information about this statement and its contributors can be
obtained from the Pregnancy Loss and Infant Death Alliance, P.O. Box 658,
Parker, CO 80134; tel. 1-888-546-2828, press 3; fax 303-649-9320;
For more information, view their website.
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