Post-mortem confirmation of fetal brain abnormalities: challenges highlighted by the MERIDIAN cohort study

Objectives

To assess and analyse the concordance between post‐mortem findings and in utero MR imaging in the MERIDIAN cohort.

Design

Prospective cohort study

Setting

Fetal medicine units in the United Kingdom

Population

Pregnant women with a diagnosis of fetal brain abnormality identified on ultrasound at 18 gestational weeks or more

Methods

All pregnancies from the MERIDIAN study that resulted in abortion were included and the rate of uptake and success of the post‐mortem examinations were calculated. In the cases in which diagnostic information about the fetal brain was obtained by post‐mortem the results were compared with the diagnoses from iuMRI.

Main Outcome Measures

Outcome reference diagnosis from post mortem examination

Results

155/823 (19%) pregnancies ended in abortion and 71 (46%) had post‐mortem brain examinations of which 62 were diagnostically adequate. Hence the overall rate of successful post‐mortem investigations was 40% and in those cases there was a concordance rate of 84% between iuMRI and post‐mortem. Detailed information is provided when the results of the post‐mortem and the iuMRI study were discrepant.

Conclusion

We have shown tissue‐validation of radiological diagnosis is hampered by a low rate of post‐mortem studies in fetuses aborted with brain abnormalities, a situation further compounded by a 12% rate of autopsy being technically unsuccessful. The agreement between iuMRI and post‐mortem findings is high but analysis of the discrepant cases provided valuable clues to how providing information to parents can be improved.