(734) Perinatal Autopsy Rates in a Contemporary U.S. Cohort

To assess the change in rate of perinatal autopsy after publication of a sentinel study in April 2017 by Page et. al which recommended inclusion of autopsy as a universal component of postmortem examination after stillbirth.

Study Design:

National Vital Statistics System fetal death data was used to create a retrospective cohort of all fetal deaths ≥ 20 weeks’ gestation in the 50 United States and District of Columbia from 2014 – 2021.  The primary outcome for analysis of this cohort was the percentage of stillbirths in which a perinatal autopsy was obtained. The exposure was time period, pre and post the study publication. Stillbirths during the year 2017 were excluded to allow time for adoption of recommendations.

Results:

There were 180,520 stillbirths reported in the US during the study period, including stillbirths that occurred during 2017. Autopsy was obtained in 34,375 (19%) of stillbirths overall. The autopsy rate was 18.7% in the pre-publication epoch, 2014 – 2016 (n=13,361) and 19.1% in the later epoch 2018-2021 (n=16,488), p=0.019.

Conclusion:

There was a persistently low rate of autopsy after stillbirth in the U.S. despite national society recommendations for universal perinatal autopsy. Although we identified a statistically significant increase from 18.7% to 19.1% after the guideline publication, this is likely not clinically significant. This study highlights a disconnect between national recommendations and clinical implementation, emphasizing the importance of continuing to identify and address barriers to autopsy consent and utilization.