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 Pania (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. See below regarding the return of the small samples of tissue and/or DNA taken during a placenta examination.

Tissue and DNA Samples: During a full post-mortem, a limited post-mortem (if internal examination is consented to) and/or placental examination, very small samples of tissue and/or DNA will be taken. These samples are 'fixed' in formalin. The fixed tissue is placed in a labelled tissue cassette and then embedded with wax to create a 'block' ( approximately 3cm × 2.5cm × 0.4 cm). Blocks are then sliced into extremely thin tissue sections (approximately 0.005mm) and then placed on microscope slides (75mm by 26 mm). Finally the tissue on the microscope slides is stained to provide contrast to tissue sections. These microscope slides are used as part of the examination. DNA is fresh tissue that is frozen either in the mortuary or the genetics department. These wax blocks, microscope slides and DNA samples are retained for future testing, and to refer to if there is another miscarriage or stillbirth from the same whānau. In most cases all the small samples of tissue will be used to make up the wax blocks and microscope slides. The wax blocks and microscope slides containing tissue can be returned to whānau once the post-mortem report has been issued, which may take 6-8 weeks. A return request can be made to the mortuary where the post-mortem took place. Laboratories regularly refer back to wax blocks and microscope slides, so it's important to understand that removing this material from the laboratory may impact any future investigations.

Returning baby and placenta to whānau: Following the examination, a mortuary technician will carefully prepare your baby to be returned to you as soon as possible with the placenta. 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. If you have any specific requirements regarding the care of your baby, please make sure these are recorded.

Travelling your baby to a post-mortem

You can choose to travel your baby to a post-mortem, or travel on the same flight as your baby to a post-mortem. Each hospital will have a specific policy about how this can happen and we encourage you to work with your 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, harakeke waka tūpāpaku, 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. Please ensure the baby is secured in the vehicle at all times. 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.