“Role Of Fetal Autopsy In Determination Of Cause Of Fetal Deaths –Study Conducted In A Tertiary Care Institute”

The study of the deceased serves to safeguard the living. Congenital malformations persist as a significant cause of perinatal mortality, comprising 25–30% in developed nations and 10–15% in developing countries like India. Notably, 3% of neonates exhibit major congenital malformations, with 0.7% experiencing multiple congenital anomalies, triggering anxiety in couples regarding potential recurrence in subsequent pregnancies. Recurrence risks vary, ranging from minimal to 25%, contingent upon the genetic component involved in the disorder's etiology. Identifying the etiology of perinatal death is crucial for providing tailored genetic counselling, particularly concerning genetic factors contributing to fetal loss. Despite the availability of numerous antenatal diagnostic modalities, fetal autopsy remains pivotal for confirming and delineating congenital anomalies AIMS: To Assess fetal autopsy's diagnostic accuracy and clinical relevance in identifying causes of fetal deaths and congenital malformations at our tertiary care institute. To Investigating parental views and factors impacting decisions on consenting to fetal autopsies, to enhance communication and support for families coping with fetal loss and congenital anomalies. Materials & Methods: This retrospective study, spanning three and a half years from January 2014 to August 2017, was conducted at the Department of Pathology, Nizam's Institute of Medical Sciences. The aim was to systematically review fetal autopsies referred to our department, comprehensively evaluating causes of fetal deaths and congenital malformations. The extended duration facilitated the inclusion of a significant number of cases, enhancing the study's robustness and generalization. Results: In our retrospective study, definitive or probable diagnoses were reached in 55% (122 out of 222) of cases examined. Of these, 63.1% (77 cases) received a definitive diagnosis. Gender distribution showed 46.7% male fetuses, and 38.9% female fetuses and gender identification was not feasible in 14.2% of cases. The majority (96.1%) of cases were less than 37 weeks gestation, indicating preterm fetal deaths predominance. Medical termination of pregnancy accounted for 71.42% of cases, while spontaneous intrauterine fetal demise constituted 28.57%. Ultrasound and autopsy findings correlated well in 83.1% of cases, with additional findings from autopsy and clinical correlation in 27.2% of cases. Discrepancies between ultrasound and autopsy findings occurred in only 2 cases.     Conclusion: The findings of our study underscore the significance of fetal autopsy in detecting and confirming congenital malformations. Despite advancements in imaging techniques such as antenatal ultrasonography and serology, fetal autopsy remains indispensable in the diagnostic process for congenital malformations.