Information for Health Professionals

Guiding parents through the post-mortem process

Whenever a baby dies, regardless of the gestation, there are many questions that parents may ask. Many of these questions can only be addressed by a full examination of the baby and placenta. The pathologist may be able to provide answers to some of the following questions:

  • Was the baby abnormal in any way?
  • Are there any findings important for future pregnancies?
  • Are any problems likely to recur in future pregnancies?
  • Could these events have been prevented?
  • Why did the baby die?

Even if these specific questions cannot be answered, information of importance can be gathered which will be of benefit in future discussions between parents and care givers. In these circumstances it is useful to know that there was, for example, no evidence of infection or physical abnormalities even if a precise cause of death cannot be stated. PathWest offers a state wide non-coronial perinatal post-mortem examination service to all hospitals in Western Australia and the following information will assist you in guiding them through this process.

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 Perinatal Pathology must be accompanied by all of the appropriate and relevant documentation before any form of examination or cremation can take place. Documentation requirements vary according to the baby’s gestational age and the funeral arrangements.

The Perinatal Pathology Department requires informed parental consent for all post-mortem examinations and Perinatal Pathology cremations, regardless of gestational age. This informed consent requirement also applies to early losses where recognisable fetal tissue is submitted. 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.

Click here for a simple summary of the documentation required.

Requirement

Download a Guide or Form

Consent for Pathology Examination

Consent for Pathology Examination for Baby Greater than 20 Weeks Gestation (NCC Form 1)

Consent for Pathology Examination for Baby Less than 20 Weeks Gestation (NCC Form 2) 

Consent for Genetic Testing Chromosomal Microarray for Fetal Loss Forms and Resources
Consent for Mementos

Consent for Cremation and Mementos for a Baby Less than 28 Weeks Gestation (NCC Form 3)

Consent for Mementos - Babies for Private Burial or Private Cremation (NCC Form 4)

Consent for Release

Patient Information Sheet and Consent Form Authorisation and Release of a Human Fetus or Placenta

Patient Information Sheet and Consent Form Authorisation and Release of Human Tissue

Further Information

Guideline for the release of a human fetus or placenta

Guideline for the release of human tissue

Release of Human Tissue and Explanated Medical Devices Policy

Documentation Requirements Clinician's Guide to Documentation For Perinatal Post-Mortem
Legal Documents

Human Tissue and Transport Act 1992

Non-Coronial Post-Mortem Examinations Code of Practice 2021

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.

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).

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 the parents have received all the necessary information regarding the post mortem procedure information to give informed consent.

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

Part B: Witness certifying that all relevant information has been provided

The witness must a senior clinician treating the patient.

Consultant, Senior Registrar or Clinical Midwife witness signature.

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 2

Part C: Verbal Consent from Next of Kin.

This is a declaration from the medical officer who has sought informed verbal consent to ensure 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: Clinical information to be completed by clinical staff

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 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.

Clinical History:

  • How mother presented to the hospital, delivery details
  • Any ultrasound results, antenatal care
  • 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.

Part E: Post-mortem examination results

Technical reports will not be sent directly to parents. The name of an obstetrician, GP or other doctor must be provided if parents wish to receive these reports.

It is here that the details of the doctor(s) nominated to receive these reports are written.

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 the parents have received all the necessary information regarding the post-mortem procedure information to give informed consent.

Page 2

Part A continued

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

Part B: Witness

The signature of the medical officer or clinical staff member obtaining the informed consent, certifying that all relevant information has been provided to the next of kin signing in Part A.

Part C: Verbal consent from Next of Kin

This is a declaration from the medical officer who has sought informed verbal consent to ensure 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

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

There is a separate page for stillbirth, neonatal infants, and children.

Page 3 – For Stillbirth

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 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.

Clinical History:

  • How mother presented to the hospital, delivery details
  • Any ultrasound results, antenatal care
  • 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

If any clinician would like to be present at the post mortem, please fill this in.

Part G: Post-mortem examination results

Technical and plain language reports will not be sent directly to parents. The name of an obstetrician, GP or other doctor must be provided if parents wish to receive either of these reports.

It is here that the details of the doctor(s) nominated to receive these reports are written.

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 parental consent. This section is to be completed by the designated/delegated officer for the purposes of the Human Tissue Act 1982 giving authority to perform a post-mortem examination 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 sign the consent for Post-mortem form.

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/

Yes, PathWest can assist you with arranging a cremation or a funeral. Cremations can be done at PathWest KEMH (babies less than 28 weeks). Alternatively, PathWest can assist with arranging private funerals or cremations (any gestational age).

Cremations at PathWest KEMH

PathWest is permissible by law to cremate babies that are still born and of less than 28 weeks gestation, provided that the correct consent and docu Perimentation has been received. There are two options to choose from:

 

A: Interment of Ashes Service

The KEMH Interment of Ashes Service is a Memorial Service where the ashes (cremated remains) of stillborn babies, up to 27 weeks & 6 Days gestation, are interred in the KEMH Memorial Garden.

The Perinatal Pathology Department conducts the cremations for the service towards the end of each month. For those parents whose babies are born at hospitals other than KEMH a letter, service details and service booklet are sent by Perinatal Pathology staff on behalf of Pastoral Care Services, informing them of the details.

This service is free of charge.

The service is held on the last Thursday of each calendar month (except December, when it is held on the third Thursday) and is conducted by the hospital’s Pastoral Care Service and welcomes parents of the babies, their family and friends.

Where consent has been given, the names of each of the babies are read and each parent and their family are encouraged to inter a portion of the ashes in the site prepared within the garden.

B: Individual cremations

As an alternative to participation in the KEMH Interment of Ashes Service, we are able to perform individual cremations where babies are cremated and the ashes retained for return to the parent(s). The same requirement of parental consent and the baby being stillborn and less than 28 weeks gestation still applies.

A fee is charged to Private hospitals that have a contract with Perinatal Pathology.

The method in which the parent(s) would like to collect separate ashes must be indicated on the cremation consent form. If parents have requested separate ashes please ensure that a health-care facility has been nominated to have the ashes sent to them to return to the parents. Please indicate on the consent form the name of the nominated individual or any alternative arrangements the parents have made for the return of the ashes. Parents may collect ashes from PathWest directly. This can be arranged by calling (08) 6458 2730.

Parents collecting ashes must produce photo ID. If another person has been nominated to collect the ashes they must have written consent from the parents as well as photo ID.

What form do I need to complete for a cremation?

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.

 

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.

PathWest provides a State wide perinatal death transport service and coordinates the transportation of all non-coronial perinatal deaths to and from Perinatal Pathology requiring a post-mortem examination and/or a Perinatal Pathology cremation together with the accompanying placentas.

Individual hospitals are not required to organise their own courier to transport a baby to Perinatal Pathology. A telephone call to Perinatal Pathology staff on (08) 6458 2730, providing details of the baby requiring post-mortem examination and/or cremation, is all that is required.

Metropolitan hospital deaths

For a perinatal death in a hospital within the Perth metropolitan area, Perinatal Pathology staff will arrange for the collection of the baby from the hospital and transport via the nominated registered funeral director. Please contact perinatal Pathology staff on (08) 6458 2730 for further assistance.

Non-metropolitan hospital deaths

For a perinatal death in a hospital outside the Perth metropolitan area, Perinatal Pathology staff will arrange for the collection of the baby from the hospital and transport via air (or road where necessary) to the Perinatal Pathology Department at KEMH with the nominated registered funeral director.

Transport ‘kits’ are provided to all hospitals that will need to send a baby by air travel. The kits contain written guidelines and all the requirements to send a baby to Perinatal Pathology at KEMH. Kits are to be used for all babies regardless of gestational age and size.

Each kit contains:

  • An unpainted transportation casket
  • A blue plastic hermetic sleeve
  • Unfrozen ice bricks for cooling during transport (please freeze)
  • Guidelines of what to do in the event of a perinatal death
  • Perinatal Pathology and transport documentation requirements
  • Packaging requirements
  • Transport documents that must be completed for all cases
  • Contact details for Perinatal Pathology, KEMH.

Kits are held in most regional hospitals and more are available if necessary. Kits are reused and distributed as required. Kits can be sent to smaller hospitals upon request.

Please contact perinatal Pathology staff on (08) 6458 2730 for further assistance.

Packaging of babies for transport

 

When sending a baby to Perinatal Pathology at KEMH, certain packaging requirements are necessary to ensure minimal post-mortem changes take place.

 

No air transport involved

  1.  Babies and placentas should be sent fresh and NOT placed in formalin, saline or any other form of fixative. The addition of tissue fixative removes the possibility of further tests (e.g. microbiology, genetics) being carried out if required.
  2. The baby and placenta must be placed in a sealed, leak proof container(s) suitable for transport. Babies over 20 weeks gestation that do not fit into a sealed leak proof container, must be wrapped in an absorbent wrap (e.g. bluey/bench under pad).
  3. All containers and wrapped babies must be clearly identified/labelled with all the baby and maternal details available, including baby’s date and time of birth.
  4. All babies must be identified by a hospital identification tag attached to the body.
  5. If a baby is for a post mortem examination or Perinatal Pathology cremation, then the appropriate documentation indicating consent must accompany the baby.

Air transport from non-metropolitan hospitals

  1. The wrapped baby or containers containing the baby and placenta must then be placed in the blue plastic protective pouch provided in the ‘kit’ to avoid leakage of fluids and dehydration. The blue plastic protective pouch must be sealed with the zip closed, then placed with frozen ice bricks into the transport casket.
  2. Documentation should be placed in a protective envelope (plastic sleeve) and put in the transportation casket for transport with the baby and placenta.
  3. Secure the lid of the casket using the screws supplied.
  4. Tape the completed Delivery Label (form three) to the lid of the closed casket.
  5. Place the completed flight documents (form one and two) with a copy of the BDM201 or equivalent in an envelope and have it accompanying the casket when delivering to the airport.
  6. Complete a consignment note provided by the airfreight agent.

NOTE:       

  1. ALL babies and placentas awaiting transportation to Perinatal Pathology at KEMH must be kept refrigerated at all times.
  2. With all cases, please include contact details of a nominated individual in case further inquiries are necessary (e.g. duty nurse manager involved with the case).

Please contact perinatal Pathology staff on (08) 6458 2730 for further assistance.

 

Documentation requirements for air transport

Form 1: Statutory Declaration - this form states that the baby has been prepared/packaged for the flight in a way acceptable to the airline and must be completed in all cases.

Form 2: Perinatal Death Transportation Form - this must be completed once flight details are known. You will be notified of these details shortly following notification to Perinatal Pathology that you have a baby requiring transportation to Perinatal Pathology at KEMH.

Form 3: Delivery Label – to be completed with the sender’s details and then taped to the lid of the closed transport casket.

Other requirements: A photocopy of the BDM201 - Medical Certificate of Cause of Stillbirth OR Neonatal Death, is required by the airline when transferring a baby to Perinatal Pathology KEMH. For a baby of less than 20 weeks gestation where a BDM201 does not exist, then a letter of declaration must be completed in lieu of the BDM201.

Consignment note: A consignment note obtained from your local airfreight agent must be completed so that each casket can be ‘tracked’ during all transport movements and costed at correct rates.

NOTE: When flights are not used for transport, alternative arrangements will be made.

Please contact perinatal Pathology staff on (08) 6458 2730 for further assistance.

 

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. 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. These 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).

Last Updated: 06/12/2021