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.
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:
- Consent must be informed. The person obtaining consent must supply adequate information about the process
- Consent must be freely given and free from coercion
- 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.
Perinatal Post-mortem Frequently Asked Questions
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).
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/
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.
In order to protect our workforce, community and those we care for from the ongoing threat of COVID-19, the service is currently live streamed via Microsoft teams and the family is not invited to attend in the memorial garden. We will send an invite to the family to join the live stream via a mobile, tablet or PC. We will also be recording the service which will be available to the family if they are unable to watch the live stream.
To connect to the live stream, the family will be asked to provide an email address. We will then send a link via email inviting them to the service. The brochure “Interment of Ashes”, which contains the date and time of the interment services, will be emailed to the family. If the family would like their baby’s name called out at the service, please let pastoral care know.
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 or email to Perinatal Pathology staff on:
(08) 6458 2730 or perinatal.pathology@health.wa.gov.au providing details of the baby requiring post-mortem examination and/or cremation, is all that is required.
Details required for transport
The following information is required before a transfer may be organised:
- Hospital Name
- Department Name
- Contact details of a nominated individual for further inquiries if necessary
- Patient name (mother of baby)
- Patient medical record number (Public Hospitals only)
- Baby’s date of birth
- Baby’s gestation
- Confirm if a post mortem examination is requested?
- Confirm if a PathWest Cremation is requested?
- Is the baby to be returned to the hospital/town for burial (Country Hospitals only) ?
- Is the Placenta with the baby? (& if not, what has happened to the placenta)?
- Confirm ID bands with mother’s name and DOB are attached to the baby
- Confirm hospital labels with mother’s name and DOB are attached to the outside of the wrapping/blankets/container and match the ID bands
- Please list the paperwork that will be accompanying baby & check it has been filled in correctly.
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 or perinatal.pathology@health.wa.gov.au 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. Kits are to be used for all babies regardless of gestational age and size.
Each kit consist of:
- An unpainted transportation casket
- A blue plastic hermetic sleeve
- Unfrozen ice bricks for cooling during transport (please freeze)
- Contact details for Perinatal Pathology, KEMH.
- Transport Label
- Letter of declaration
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 or perinatal.pathology@health.wa.gov.au 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.
- 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.
- The baby and placenta must be either placed in a sealed, leak proof container(s) suitable for transport or be wrapped in an absorbent wrap (e.g. bluey/bench under pad).
- All containers and wrapped babies must be clearly identified/labelled with all the baby and maternal details available.
- All babies must be identified by a hospital identification tag attached to the body.
- 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
- The wrapped baby or containers containing the baby and placenta must 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.
- Documentation should be placed in a protective envelope (plastic sleeve) and put in the transportation casket for transport with the baby and placenta.
- Secure the lid of the casket using the screws supplied.
- Tape the completed Delivery Label to the lid of the closed casket.
- Tape the completed Letter of Declaration to the lid of the closed casket.
- Complete a consignment note provided by the airfreight agent.
NOTE:
- ALL babies and placentas awaiting transportation to Perinatal Pathology at KEMH must be kept refrigerated at all times.
- 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
- Delivery Label – to be completed with the sender’s details and then taped to the lid of the closed transport casket.
- Letter of Declaration – to be completed and then taped to the lid of the closed transport casket
Consignment note: A consignment note with the AWB number obtained from our transport team must accompany the casket so it can be ‘tracked’ during all transport movements and costed at correct rates. This will be given to either hospital staff or funeral director accompanying the casket to the airport.
NOTE: When flights are not used for transport, alternative arrangements will be made.
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.