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National Perinatal Pathology Service

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    Alert Level 3/2 - Perinatal pathology investigations continue as normal, nationwide. If there is any change to our service availability we will ensure that all stakeholders are informed, promptly. Referrers are encouraged to use the usual referral process for your DHB, and your perinatal pathology requirements will be discussed on a case by case basis. We have full staff capacity and our service remains “business as usual”.

    The National Perinatal Pathology Service provides non-coronial post-mortems, including internal, external and placenta examination in the following situations:

    • stillbirths and terminations of pregnancy from approximately 14 weeks gestation to term for fetal abnormality, high-risk pregnancy, terminations and intrauterine deaths
    • neonatal deaths (up to 28 days).

    The National Perinatal Pathology Service is whānau-centred. You have the right to be asked if you would like a post-mortem examination, and a non-coronial post-mortem examination cannot happen without your consent.

    A non-coronial perinatal post-mortem examination can be an important step in understanding why your baby or babies have died. It can be a daunting and sometimes confronting procedure to consider.

    Understanding the post-mortem examination, the different types of examinations available, and the benefits may help to overcome any concerns you have and help you decide if a post-mortem is likely to be helpful in understanding the cause of the death and if it is right for your whānau.

    A New Zealand study reported on interviews with 169 mothers who gave birth to a stillborn baby after 28 weeks of pregnancy. Ten percent (7 of 70) mothers who declined a post-mortem said they would not make this decision again. No mother (0 of 99) who agreed to a post-mortem regretted her decision.

    Cronin R, Li M, Wise M, et al. 2018. Late stillbirth post mortem examination in New Zealand: maternal decision-making. Aust NZ J Obstet Gyn 58(6): 667–73.

    The National Perinatal Pathology Service does not coordinate coronial post-mortems, this is the responsibility of Coronial Services, which is part of the Ministry of Justice. You can find out more information about the coronial service and how to contact the service on the website Coronial Services of New Zealand.

    Procedures

    Perinatal Pathology Centres

    The Service is provided by Auckland and Canterbury District Health Boards, with perinatal pathologists based in Auckland, Wellington, Christchurch and Dunedin. The Service is primarily provided during normal business hours unless circumstances warrant more urgent access. 

    The post-mortem examination will take place in a mortuary. Each mortuary has a Whānau room where you can wait until the post-mortem is complete if you wish. You can also choose to transport your baby to the mortuary where the post-mortem examination will take place and your maternity care team will help to coordinate this. 

    Auckland
    Your baby will go to the Auckland City Hospital mortuary, Labplus, Building 31, Gate 4, Grafton Road. The Whānau room is on the ground floor at the front of the LabPlus building and can be accessed from outside the building. Limited parking is available on the courtyard directly outside the Whānau Room, or there is the Wilson Carpark B, close to the LabPlus building (charges apply).

    Wellington

    Your baby will go to the Wellington Hospital mortuary, which is behind the Emergency Department building of Wellington Hospital. If you are transporting your baby to the mortuary, you will be received by mortuary staff and then accompanied by a staff member to the Ngaio or Rata room. There is paid parking available either in the main car park under the hospital, via the Riddiford Street entrance, or off Mein street (park between the green lines only).

    Christchurch

    Your baby will go to the Christchurch Hospital mortuary, on Riccarton Avenue in Christchurch. There is limited on-street or paid car parking near Christchurch Hospital. You can call to hear pre-recorded information about the current parking situation - call 0800 555 300 for parking information only.

    Dunedin

    Your baby will go to the Dunedin Hospital mortuary, on Cumberland Street in Dunedin. Metered parking is available in surrounding streets within walking distance. These range from 30 minutes to all day parking limits. Someone from the mortuary can meet you in the Queen Mary Maternity whānau room as the Dunedin Mortuary whānau room is currently in the process of being refurbished. 

     

    Who is involved with the National Perinatal Pathology Service?

    Perinatal Pathologists: Perinatal pathologists are Doctors who have trained in anatomical pathology (study organs and tissues to help determine the cause and effect of diseases) and specialised in perinatal pathology. The perinatal pathologist performs the post-mortem examination on the baby/babies.

    Mortuary Technicians: Mortuary technicians assist the perinatal pathologist with the post-mortem process. This can include liaising with whānau, transporting a baby to the examination, preparing the required paperwork, and preparing a baby to be returned to their whānau.

    Service Leadership and Administration: The National Perinatal Pathology Service is led and administered through the Auckland District Health Board. There is a Service Delivery Team, and a National Clinical Network that oversees the implementation of the service Action plan.

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    What is involved in a post-mortem examination?

    A non-coronial perinatal post-mortem examination of your baby can only be performed with your consent. A full post-mortem examination will provide the most information to assist in the understanding of why your baby died, and in identifying risk of recurrence in future pregnancies. Limited post-mortem (confined to selected organ(s)), external-only examinations and placental examinations are still valuable examinations to consider.

    A perinatal post-mortem is a surgical procedure for gathering information about why a baby has died. A perinatal pathologist will examine the baby to look for signs of infection, disease or something unusual that may explain the cause of death. The placenta will also be examined as part of the post-mortem. Post-mortem can include internal and external examination, blood and tissue tests and imaging.

    Dr Vicki Culling and Lisa Paraku talk about what parents, family and whānau can expect when choosing a post-mortem for their baby https://www.youtube.com/watch?v=O2jijqJs0K0&t=8s

    Types of post-mortem

    Full post-mortem examination: A full post-mortem examination may include all of the following: external examination; internal examination of the brain, chest, and abdomen; examination of the placenta; genetic testing; radiology; clinical photographs. The perinatal pathologist will examine your baby externally and internally looking for abnormalities that reflect abnormal development or possible infection as well as other pathologies that may explain the death. A surgical Y-shaped incision is made from each shoulder and down the midline, and also at the back of the head. The hands, feet and face are not changed, only visually examined. A small sample of tissue and/or DNA may be retained for future diagnostic testing, and you can request the return or disposal of any samples taken during the post-mortem examination. No organs will be retained unless you have given consent. Once the examination is complete, all incisions will be stitched and a dressing will be applied. Your baby will be carefully washed, dressed and returned to you.

    Limited post-mortem examination: There may be elements of a full post-mortem that you do not wish to consent to. You can select a limited post-mortem examination, which allows you to choose what elements of a post-mortem examination you wish to consent to. This could include examination of the abdominal organs only and no incisions on the head, or simply a placenta/whenua examination. It's important to know that a limited post-mortem may only provide limited information.

    External examination only:  You can consent to an external examination only, which could include x-ray (performed at the discretion of the pathologist), external examination of the baby’s body and the placenta/whenua. This means that the pathologist would not examine any internal organs at all. As with a limited examination, the external examination may only provide limited information.

    Whenua/Placenta examination only: If you decide not to have any type of post-mortem for your baby, examining your whenua/placenta could still be helpful in finding a cause for your baby’s death. The whenua/placenta will need to be dissected. Once the examination is complete, the whenua/placenta can be returned to you.

    Tissue and DNA Samples: During a full post-mortem and a limited post-mortem (if internal examination is consented to), very small samples of tissue and/or DNA may be taken. These samples are fixed in wax blocks (3 × 2.5 × 0.4 cm), or stained and stored on a microscope slides (75 by 26 mm) and used as part of the examination. DNA is fresh tissue that is frozen either in the mortuary or the genetics department. These tissue and DNA samples are retained for future testing, and to refer to if there is another miscarriage or stillbirth from the same family. These samples may be returned to whānau on request.

    Returning baby and/or placenta to whānau: Following the examination, a mortuary technician will carefully prepare your baby to be returned to the family. Your baby may be washed, and will be re-dressed in the clothes they travelled in, clothes supplied by the mortuary, or clothing provided by the family. 

    Travelling your baby to a post-mortem

    You can choose to travel your baby to a post-mortem. Each hospital and DHB will have a specific policy about how this is supported and we encourage you to work with you maternity support team if you would like to travel with your baby.

    How a baby will travel to a post-mortem depends very much on the mode of transport that is to be used.

    Perinatal pathology mortuary at the Hospital: Your baby can be swaddled and carried down to the hospital mortuary for the post-mortem. There may be specific lifts dedicated to transporting tūpāpaku (body of the deceased) that you can use.

    Travel to a perinatal pathology mortuary by car: Your baby can travel in a vehicle with you, or your maternity support team will arrange for your baby to be transported by a Funeral Director or a Hospital staff member. Your baby can be transported in a bassinette, wahakura, cocoon, or casket, as long as they are kept cool for the duration of the trip. This can be as simple as some ice packs placed underneath your baby, that are replaced regularly. It is important to have the relevant documentation (or forms) when travelling with the tūpāpaku should you need to show them to anyone. The documentation you need for a stillborn baby or a baby who has died after birth is the ‘Transfer of Charge of Body’ form (BDM 39) and the Medical Certificate of Causes of Fetal and Neonatal Death (HP4721), both of which you will receive from the hospital or mortuary.

    Travel to a perinatal pathology mortuary by plane: Your maternity support team will need to organise for your baby to travel by plane. Travel by plane will require your baby to be securely packaged in a rigid container and the container will be placed into the hold of the plane, not in the cabin. 

    Referral Expectations

    Your maternity support team can discuss the options available for a perinatal post-mortem examination. If you consent to a perinatal post-mortem, your maternity support team will complete the referral process on your behalf, once you have signed the perinatal post-mortem consent form. When organising perinatal post-mortems, our service providers will always endeavour to provide a date and time that suits the needs of the whānau. 

    Referral boundaries for the Service are not fixed and to ensure a streamlined, consistent service each hospital provides back up and support as required. In general, referrals to the Service are as follows:

    Auckland DHB, provided through Auckland Hospital: Northland, Auckland, Counties Manukau, Waitematā, Waikato, Bay of Plenty, Tairāwhiti, Lakes, and Taranaki DHBs. Capital & Coast DHB, provided through Wellington Hospital: MidCentral, Whanganui, Hawke’s Bay, Capital & Coast, Hutt Valley, Wairarapa and Nelson/Marlborough DHBs. Canterbury DHB, provided through Christchurch Hospital: West Coast, Canterbury, and South Canterbury DHBs. Southern DHB, provided through Dunedin Hospital: Southern DHB.

    Perinatal post-mortems will be completed as soon as is possible following a referral, within 2 business days. The post-mortem report will be made available to your Clinical support team within 8 weeks of the investigation. In some cases the report may take longer to complete if specialist tests are required.

    A post-mortem report contains complex medical language and will include a description of findings highlighting and/or describing any abnormalities and providing a diagnosis where appropriate. You will be asked to come into the hospital for an appointment and your obstetrician will talk through the results You can request a copy of the post-mortem report from your obstetrician once you have had a meeting to discuss the results. 

    For health professionals, specific details relating to the referral process are located in the clinicians' section of Healthpoint. Please contact perinatalpathology@adhb.govt.nz if you require access.

    Charges

    New Zealand citizens or permanent residents are entitled to publicly funded healthcare. Non-residents may be required to pay for their healthcare.