Information for Health Professionals

Guiding next-of-kin through the post-mortem process

When a child dies, there are often many questions that parents may ask. Many of these questions can only be addressed by a full examination of the child. The pathologist may be able to provide answers to some of the following questions:

  • Why did the child die?
  • Could these events have been prevented?
  • Were there any unknown medical conditions?

Even if these specific questions cannot be answered, information of importance can be gathered which may offer some answers. In these circumstances it is useful to know that there was, for example, no evidence of infection or abnormalities even if a precise cause of death cannot be stated.

Download a printable version of information for parents and next-of-kin.

Consenting to a post-mortem

Consent to perform a post-mortem is a requirement under law. We suggest that it is most appropriate for the senior clinician treating the patient to approach the family regarding a post-mortem, rather than delegate this duty to a junior medical officer or untrained interviewing officer. Requesting a post-mortem and discussing organ retention and other sensitive information should be conducted face-to-face wherever possible. 

The three principles guiding consent are:

  1. Consent must be informed. The person obtaining consent must supply adequate information about the process
  2. Consent must be freely given and free from coercion
  3. The person giving consent must understand what is about to occur.

Who can obtain consent?

Consent is to be obtained by a senior clinician treating the patient and the signature of a senior clinician is required before the post-mortem can proceed.

A senior clinician treating the patient is defined as follows:

  • Consultant Obstetrician
  • District Medical Officer (DMO)
  • Senior Medical Officer (SMO)
  • GP Obstetrician
  • Fellow in Obstetrics and Gynaecology
  • Clinical Midwife who is a subspecialist in the perinatal loss service
  • Registrar who is specialising in obstetrics and gynaecology.

Any of the above clinicians may obtain consent. The clinician’s signature must be provided and their name clearly legible. Where a clinical midwife or a registrar obtains informed consent, they must not only sign the consent form but also provide the name of the consultant (who should be aware that the post-mortem is taking place).

Documentation and forms

Each case received by the mortuary must be accompanied by all the appropriate and relevant documentation before any form of examination can take place.

PathWest requires informed parental consent for all post-mortem examinations. Before any examination or cremation of recognisable fetal tissue is conducted, the pathologist must confirm parental permission for the examination (and cremation if requested) has been sought and obtained.

 

Requirement

Download a Guide or Form

Consent for Pathology Examination

Consent for Post Mortem Examination (Non Coronial)

Consent for Genetic Testing Chromosomal Microarray for Fetal Loss Forms and Resources
Legal Documents

Human Tissue and Transplant Act 1992

Non-Coronial Post-Mortem Examinations Code of Practice 2022

Non-Coronial Post-Mortem Examinations Amendment Code of Practice 2008

 

Perinatal Post-mortem Frequently Asked Questions

The informed wishes of the parents are the basis of what happens to their baby after death. The choice of a post-mortem examination is always determined by the parents and there are varying options, regardless of the gestational age of the baby:

Full

A full post-mortem examination is of most benefit as it allows the pathologist to examine all of the organs of the baby. They can provide a very detailed report of any external or internal abnormalities, structural defects and organ growth, making available the maximum possible information. It is often a great help for parents when coming to terms with the death of their baby to feel that they, through their decision to permit a full post-mortem examination, are in possession of all the relevant facts that could possibly be known.

A full post-mortem includes an x-ray and photographs; these are taken to create a permanent record. At the time of the examination, the pathologist does a full external and internal examination. The face, limbs and hands are never cut. Each of the individual organs is examined, weighed and small samples from every organ are taken for microscopic examination, which are kept indefinitely as a permanent record. If necessary, small samples are taken for investigating infectious organisms or numerical chromosomal abnormalities.

Whole major organs (eg: heart, brain, liver), are not retained without specific consent from the parents and then only for a limited time to allow full fixation and detailed examination before being returned to the body or disposed of in accordance with the parents’ wishes. The placenta, if received, is also examined at this time. All remaining tissues are returned to the body at the end of the examination for burial or cremation.

Limited

This applies when there are restrictions placed on the examination. The extent of a limited post-mortem examination can vary and will include the examination involving only the areas selected by the parents in discussion with their doctor, the pathologist or the post-mortem coordinator. The focus can be directed towards a specific problem that has been identified during pregnancy or after delivery, such as a heart defect or a specific abnormality of an organ. External, x-ray and placental examinations are also done and photographs are taken for the permanent record.

Parents have the right to restrict an examination to any organ or part of the body if they choose; however, they should understand that abnormalities in one part of the body are often accompanied by important abnormalities elsewhere, which may only be seen at a full post-mortem examination. This procedure will not provide the same amount of useful information as a full post-mortem examination.

External

This applies when only the outside of the baby’s body is examined. X-rays are taken and the placenta is examined (if available). No cuts are made and no internal organs are studied. A portion of the umbilical cord or placenta may be stored for future investigation, including genetic studies. Clinical photographs are taken and stored in the department as a permanent record. Some useful information can be gained by measurements and x-rays but no comment can be made on organ development and form.

Placenta only

Parents may not wish for a post-mortem examination to be performed. However, valuable information can still be obtained from the examination of the placenta and placental examination is strongly advised for any fetal death.

Obtaining tissue for genetic testing

Autopsy tissues may be used for genetic testing and it is usual for a small tissue sample to be stored frozen so that DNA is available for studies should further testing be required following the autopsy.

If microarray or other detailed molecular testing is indicated, the attending physician requesting the autopsy should complete the request form with the parent’s full informed consent and submit the form with the autopsy consent.  The Pathologist will submit the tissue for testing with the completed request for genomic testing.  The Pathologist is unable to initiate the request as part of the autopsy.

Perinatal Pathology does not offer CT scanning or imaging other than basic radiology as part of the post mortem examination.

Organs are not routinely retained. A small portion (approximately the size of 5 cent coin) of each organ is sampled, but no whole organs are retained. As part of the post-mortem procedure, it may be necessary to fix an organ in formalin for up to 24 hours before further sectioning takes place. This is to allow for detailed the dissection where there are complex congenital abnormalities.

Non-Coronial mortuaries do not offer CT scanning or imaging other than basic radiology as part of the post-mortem examination.

Yes, a child who dies outside of the hospital may have a non-coronial autopsy. The treating clinician will need to complete a post-mortem consent form as per usual practice. The post-mortem coordinator can assist with this process. The PCH mortuary staff will arrange the transport of the child to the appropriate PathWest facility for post-mortem. A Paediatric Pathologist will perform the post-mortem. To discuss the post-mortem and request the transfer, please contact the PCH mortuary staff.

PathWest Paediatric Pathologists are able to provide routine neuropathological examination. The department has access to expert neuropathology opinion (from the neuropathology Department at Royal Perth Hospital). When a neuropathology examination is required, it is best practice to fix the brain for up to 2 weeks before processing, to allow for more detailed examination. Please consider obtaining consent for retention for up to 2 weeks.

 

Yes, genetic testing is available. A separate request form with the parent’s full informed consent must be submitted with the autopsy consent. Tissue for genetic testing can be taken at the time of a full post-mortem, a limited post-mortem (usually, a small piece of muscle is taken from the leg through a small incision) or an external post-mortem (a portion of umbilical cord or placental tissue is taken).

The NNC Form 1 is to be filed in for all Perinatal (regardless of gestation) & Paediatric examinations.

Page 1

Part A: Senior Available Next of Kin Consent

The Senior Available Next of Kin (usually the parents) must complete this section, to ensure that they have  received all the necessary information regarding the post-mortem procedure information to give informed consent that is free from coercion. The information they require can be found on the PathWest website at… Alternatively, the information can be printed and handed to the senior available next of kin (the printed information can be found at….

There is a declaration at the bottom of this page that requires the signature of the next of kin giving the informed consent.

Page 2

Part B:  senior clinician certifying consent has been obtained and all relevant information has been provided

The section is completed by the senior clinician who has obtained consent who by signing the section certifies that all relevant information has been provided to the Senior available next of kin signing in part A.

Part C: Verbal consent from Next of Kin

This is a declaration from the senior clinician who has sought informed verbal consent from the Senior available next of kin confirming that  that the next of kin have been provided with all the relevant information on all points raised on this form, that the next of kin have given informed consent for a post-mortem examination to be performed and have indicated, where required, their conditions of consent.

Part D: Consultant, Senior Registrar or Clinical Midwife Signature

The section is to be completed by the consultant, Senior registrar or clinical midwife seeking consent. consent is to be obtained by a senior clinician treating the patient and the signature of a senior clinician is required before the post-mortem can proceed.

A senior clinician treating the patient is defined as follows:

  • A Consultant Obstetrician
  • District Medical Officer (DMO)
  • Senior Medical Officer (SMO)
  • GP Obstetrician
  • A Fellow in Obstetrics and Gynaecology
  • A Clinical Midwife who is a subspecialist in the perinatal loss service
  • A Registrar who is specialising in obstetrics and gynaecology.

Any of the above may obtain consent. The clinician’s signature must be provided and their name clearly legible. Where a clinical midwife or a registrar obtains informed consent, they must not only sign the consent form but also provide the name of the consultant (who should be aware that the post-mortem is taking place).

Page 3, 4 and 5

Part E: Clinical information to be completed by clinical staff

Depending on the age of the child and a type of death, different clinical information is required. Accordingly, please provide relevant clinical information as per below :

  • Page 3 – For Miscarriages, Fetal Deaths or Stillbirths (regardless of Gestational Age)
  • Page 4 – Neonates (Up to 28 days of Life) & Infants (28 days to one year of life)
  • Page 5 – Children (1year to 18 years of life)

The completion of this section must be done by the referring doctor or clinical staff. It is of great importance as it provides the pathologist with the clinical history, current pregnancy information and previous obstetric history. If there is a lack of information in this section of the documentation, it will be returned for completion before an examination takes place.

Relevant clinical History includes (but is not limited to):

  • How mother presented to the hospital (for example bleeding, rupture of membranes, decreased fetal movementsetc)
  • Delivery details
  • Any ultrasound results
  • Antenatal care (or lack there of)
  • Previous losses, gravidity and parity
  • Any medications/drugs
  • Any history of smoking or alcohol use
  • Any genetic or other testing done e.g. NIPT, amniocentesis, Keilhauer.

NOTE: Copies of any relevant radiology or genetic reports should accompany the consent form.

Page 6

Part F: Clinician Attendance

The section is to be completed if any clinician would like to be present at the post-mortem

Part G: Post-mortem examination results

The results of the post-mortem are automatically sent to the consultant listed at part D, page 2. Further copies of either the technical report or the plain language report can be provided to medical staff and the name of an optician, GP or other Dr should be provided in this section. PLEASE NOTE: Reports will not be sent directly to senior available next of kin.

Part H: Paperwork requirements

This section is to explain what paperwork, other than the consent form, is to be sent with the baby and placenta. The section also explains the paperwork requirements for genetic testing.

Page 7

Part I: Post-mortem Coordinator

As part of the Non-Coronial Post-Mortem Examinations Code of Practice 2007, a post-mortem coordinator is employed by PathWest to ensure that informed consent is received before any examination takes place. Only the appointed post-mortem coordinator can complete this declaration.

Part J: Authority for post-mortem examination

This is not to be completed by the requesting doctor obtaining senior available next of kin consent. This section is to be completed by the designated/delegated officer, in accordance with  the Human Tissue Act 1982, who gives authority for a  post-mortem examination to be conducted at PCH.

Part K: Pathologist

The Perinatal Pathology Department will complete this section.

Part L: Guideline for obtaining consent

This section is to explain who may seek consent from the senior available next of kin for post-mortem examination and sign the consent form, confirming that all relevant information has been provided for senior available next of kin to make an informed decision.

NOTE: For more information on non-coronial post mortem examinations and to view the Non-Coronial Post Mortem Examinations Code of Practice of 2007 go to: www.health.wa.gov.au/postmortem/

No, it is always the parent’s choice. A non-coronial post-mortem examination can only be carried out with parental consent. Parents do have the right to request a post-mortem examination if one is not offered.

Tissue will not be used for research purposes unless parental consent is given. Any research that takes place will have the approval of the hospital’s ethics committee.

During any post mortem examination, a medical student, junior doctor, midwife, nurse or laboratory technician may be present as part of their training.

The pathologist writes a detailed report, listing the findings made and results of any special investigations. The preliminary report containing information obtained from the naked eye inspection at the time of the post-mortem examination should be available within two working days following the autopsy.

The final report containing the histology findings and any other test results may not be issued for up to six to eight weeks, depending on abnormalities found or when results of additional tests (e.g. microbiology, radiology and genetics) carried out at the time of the post-mortem examination are reported.

To avoid misunderstandings it is essential that the report is initially given, with an explanation of the contents, by their obstetrician, GP or other doctor.

It is possible for parents to see and, if they choose, hold their baby after a post-mortem examination. More information about creating memories is available on the Information for Families page.

Yes. Clinical photographs are taken for every post-mortem. These photographs may be shared with other treating clinician's. In addition, we are able to take photographs that can be taken home by parents (these are done in a sensitive manner). We are also able to make hand-and-foot imprints for parents to take home, provided consent is given. All mementos are stored indefinitely and are available should parents request them at the time of their baby’s birth, or days and years following the death of their baby.

What form do I need to complete for mementos to be taken (photographs, hand and footprints?

For a baby having a KEMH cremation – NCC Form 3.

For a baby going for a private funeral or private cremation outside of KEMH – NCC Form 4.

How do parents collect mementos?

Parents collecting mementos must produce photo ID. If another person has been nominated to collect the mementos they must have written consent from the parents as well as photo ID. Mementos may be collected from PathWest Perinatal Pathology, Pastoral Care Services, a nominated hospital or general practitioner, or posted to the parents.

Quiet Room

The Perinatal Pathology facilities include a quiet room that can be used by parents and their families to spend time with their baby once they have been discharged from hospital.  Bookings to arrange convenient viewing times are required and can be made by phoning the department on (08) 6458 2730. Parents are required to produce photo ID when arriving at Perinatal Pathology.  Parents are welcome to spend as long as they like in the quiet room with their baby, subject to other bookings that may have been made for the same day.

A plain language report is a report completed by the pathologist detailing his/her findings of a post-mortem examination in plain English that is understandable by people with a non-medical background. These are not done routinely but can be requested when completing the post-mortem examination consent form or at any time following.

Reminder: Technical and plain language reports will not be sent directly to parents. When these reports are requested, the name of a doctor who is able to explain the findings, a GP, obstetrician or other doctor must be provided.

A small biopsy (roughly the size of a pea) is routinely taken from every major organ for microscopy to detect disease, similar to how biopsies are taken during life to determine if disease is present. This tissue is processed into a paraffin block from which a microscope slide is produced. This material is kept indefinitely. Some tissue may be sent to other departments such as microbiology or virology, depending on what the pathologist thinks the underlying disease process is. In most cases, a small pea-sized piece of tissue is frozen in a special way if any further testing (such as genetics) is required in the future. Any genetic testing can only proceed with your permission and a separate consent form will need to be signed by your treating doctor. All remaining tissue is returned to the body at the conclusion of the post-mortem.

Unless permission is specifically granted, all tissues are returned to the body at the conclusion of the post-mortem. A pea-sized sample is taken from every major organ. From this, a paraffin block and microscope slide is produced for microscopic examination to detect disease with some samples being frozen or sent for testing within other departments (e.g. genetics, microbiology, virology). The paraffin blocks and microscopic slides are kept indefinitely as part of the patient record and can be referred to at a later stage (e.g if new genetic tests become available). The frozen samples are kept for up to 20 years and may be sent to Diagnostic Genomics for further testing. Genetic testing requires specific permission and will discussed with you by your treating doctor.

Last Updated: 21/09/2022