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In the guidelines published by the Royal College of Pathologists(1,2) (March 2000), it was agreed that 'a senior and properly trained doctor, preferably a consultant, ……should obtain agreement to the post-mortem examination.' They recommend that medical schools and hospitals should provide the training in this area for medical and other appropriate personnel. Another suggestion is that the consent forms should be filled in by medical staff in conjunction with a bereavement officer, who deals with these situations on a regular basis.

Understanding what is involved in the procedure of a post-mortem means that staff can reassure the parents that their baby will be dealt with respectfully and compassionately. There should be no ambiguity that a full post-mortem requires an internal examination and that organs need to be removed and examined, with tissue samples being taken for further testing. This involves a Y incision abdominally and another incision through a suture in the skull to examine the brain. Both of these incisions are then sutured and would be invisible to the parents with a baby-grow and bonnet. A great fear for parents is that their babies have suffered enough and would be disfigured by further investigation.

Emphasis has been made on gaining FULLY INFORMED CONSENT. This means giving comprehensive information on which to base a decision - information that is detailed and specific on what procedures are being consented to and at the same time, user-friendly. Unfortunately, there is only one opportunity for a post- mortem to be performed and this is at a very difficult time for parents who are newly grieving and trying to come to terms with the loss of their baby. Perhaps it is we, the clinicians, who shy away from explaining the importance of a post-mortem to the patient because it is a difficult subject and we are afraid of making their distress worse. Experience shows that parents are more amenable to considering a post-mortem if they are given all the relevant information and had the advantages explained. These include:

• Confirming a diagnosis. It may be as important to exclude a possible diagnosis
• Implications for future pregnancies and other children
• Finding an explanation for the parents to understand why their baby died in order to help them come to terms with their grief
• Although a clinical diagnosis may already have been made (eg. Placental abruption) an important underlying condition may be missed that may have future implications

It is important that we understand that a post-mortem is undertaken on behalf of the parents to gain as much information as we are able in order to make a diagnosis for them.

References

1. Examination of the body after death. Information about post-mortem examination for relatives. The Royal College of Pathologists. March 2000
2. Guidelines for the retention of tissues and organs at post-mortem examination. The Royal College of Pathologists. March 2000