Post Mortem In Current Practice Flashcards
What does certifying death mean
Declaring whether the patient is dead can be done by health professionals of different levels/nursing staff/paramedics
What does it mean to complete a death certificate
If you are a registered medical practitioner and were in attendance during the deceased’s last illness, you are required to certify the cause of death
The cause(s) of death should be stated to the best of belief
How is the Death Certificate processed
The certification for the registration of death done at the hospital is not the death certificate
The certificate is taken to the register to complete the death certificate: this is done for legal issues, you might need to stop payment or start processing payment
What is the purpose of death certificates
- Provides legal evidence of the fact and causes of death, thus enabling the death to be formally registered; the family can then decide for the disposal of the body
- Death certification also provides the raw data from which all mortality statistics are derived. This is crucial for public health surveillance, a wide range of research an improving health of population
What are the 3 types of death certificates
1) Medical certificate of cause of death - Any death occurring after the 28 days of life
2) Neonatal death certificate - Any death of a live-born infant occurring within the first 28 days of life
3) Certificate of stillbirth - Any death of an infant that has been issued forth from its mother after the 24th week of pregnancy and which did not breathe or show any other signs of life at any time after being completely expelled from its mother
Why is the certificate of Stillbirth used
To understand whether there was a problem with the delivery or whether the foetus or the baby died before the labour started or before the health professionals were involved.
When and why are post-mortems used
It is only when it is not clear what has caused the death that post-mortem is used
This is because it might not be known whether there were any prior health conditions
Surgery for example, would have post-mortem to see if the death was caused by the surgery or if the disease had progressed faster than expected.
Only when specific questions are needed to be answered is post mortem required because its highly invasive and expensive.
How is perinatal death investigated
This can be done in utero or during labour.
The placenta is also investigated and stored for a while
What happens if the baby and the mother are healthy
The placenta is described at brith to make sure that it has been removed in one piece a dn then incinerated.
What happens if there are complications for the baby and the mother during delivery
The placenta is examined to see if the cause of the problem can be identified. If the baby survives, the investigation can be stopped but if the baby dies, the post mortem is conducted
What is the purpose of perinatal postmortem
- The placenta might have some abnormal features, even those that work perfectly well during pregnancy and are not associated with any complications may have areas of haemorrhage or infarction.
- Bereaved parents should have the option to know why their baby died
- Any information that is obtained should be helpful in reducing risks of loss in future pregnancies
- The information has important personal implications, especially to plan and manage future pregnancies.
What are the common clinical indications for post-mortem
- Terminations of pregnancy for foetal abnormality
- Hydrops fetalis: swelling oedema of the foetus body due to incompatibility of the rhesus foetus factor
- Suspected intrauterine infection: risk of infections that can get through the placenta membrane and affect the baby
- Death of twins or higher order multiples
What are other common clinical indications of perinatal autopsy
- Unexplained foetal growth retardation
- Unexplained foetal losses
- Malformed foetuses and babies
- Unexplained neonatal deaths, SIDS
What does the external examination of perinatal examination include
- Body weight to the nearest gram
- Head circumference
- Foot length
- Maceration is the baby is born dead
- Dysmorphic features/congenital malformations and deformities
- Length of bones to see if growth was consistent with gestational age
-Fractures of long bones and ribs
What does the internal examination of perinatal examination include
- Cranial, thoracic and abdominal cavities
- Systematic description of major organs and tissues
- Weigh all major organs on a digital balance
- Comment on skeleton
What are special investigations of perinatal examination include
- X-ray mandatory for suspected skeletal dysplasia and multiple malformations without ante
- Bacteriology (blood/spleen/lung/cerebrospinal fluid)
- Virology, if clinically indicated
- Karyotype, if clinically indicated
What are the causes of perinatal deaths
1) Spontaneous preterm delivery and hypertensive disorders
2) Prematurity - main cause of early neonatal deaths
3) Death associated with foetal abnormalities
What are the 5 most common chromosomal disorders
Trisomy 21 - Down syndrome
Trisomy 18 - Edwards syndrome
Trisomy 13 - Patau’s syndrome
Triploidy
Turner’s Syndrome
How are these chromosomal disorders diagnosed
This used to be done by performing amniocentesis but this had the risk of infection
This could also be done by the invasive analysis of the chorionic villi.
It is now done by looking for the foetal blood present in the mother’s blood - this makes it easier, safer and more accessible
How can diabetic mothers have complications that lead to perinatal death
- Macrosomia: increased risk of problematic delivery
- Increased frequency of malformation
- Hypertrophy of islets of Langerhans with beta cell hyperplasia and hyperinsulinemia: causing them to become dysmetabolic when they are born
How can preeclampsia lead to perinatal death
- Unknown cause
- Clinically maternal high BP and protein in the urine
- Autopsy finding: Intrauterine Growth Restriction of the foetus
- If there was pre-eclampsia in the first pregnancy it is possible that it would be there in the following pregnancies as well
What are common pathological findings in perinatal autopsy
- maceration - skin slippage
- Intraventricular haemorrhage
- Anencephaly - absence of brain or skull vault
- Spina Bifida - neural tube defect
- Hydrops - generalised oedema of the foetus (rhesus syndrome)
- Atresia of the bowel
- Single palmar crease (trisomy 21)
- Oligohydramnios: wrinkled glove like skin - associated with the malformation of the kidneys.
What is Atresia of the bowel
Very enlarged bowel which is not connected to the rectum. The oesophagus may not be connected to the stomach and is instead attached to the trachea - once the babies are born and drink milk, the milk will get into the lungs. This defect must be identified ASAP and requires surgery
What causes Oligohydramnios
If the kidneys of the foetus are malformed, the foetuses are not producing pre-urine. Urine is part of the amniotic fluid and because there is less amniotic fluid, there would be less hydration and cause extreme wrinkles on the baby
