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. One way for parents to better understand what has happened is through a post-mortem examination of the baby and placenta. Caring for a family after the loss of a baby will leave a lasting impression, and your role is very important to ensure the family feels supported and well informed in the decisions they are making. For the latest clinical practice guidelines please refer to the Stillbirth CRE guidelines and PSANZ Care Around Stillbirth and Neonatal Death.
You may also like to refer to the RedNose video Talking to parents about autopsy for stillborn babies which may assist with guiding parents on their choices around post-mortem examinations.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).
Clinical Resources
The following videos provide information on requesting a post-mortem and arrangements for transport.
Placenta
The following videos describe the normal placenta and its functions and common problems that can occur.
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
No, unless parents provide consent for an organ to be retained (NCC FORM 1 – PART 3, pg3), all organs are returned to the body. However, as some organs such as the brain, cannot be examined satisfactorily without chemical treatment (called fixation). You may be contacted by PathWest Perinatal Pathology to obtain permission to keep the organ a little longer to aid the information gathering during the examination. If permission is granted and an organ is retained for fixation, the options for cremation and burial include:
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, PART 3 NCC FORM 1.
Yes, there is an option available on the consent form under each post-mortem type, for parents to tick ‘yes’ or ‘no’ to tissue being removed for genetic or metabolic testing. If the post-mortem examination is being limited to genetic tissue only, consent is required on NCC FORM 1 at part 2c2. Tissue is routinely taken and stored for further genetic testing (a pea-sized sample that is snap frozen).
NCC Form 1
Please refer to How to complete post-mortem consent educational video for a step-by-step guide. The NNC Form 1 is to be filed in for all Perinatal (regardless of gestation) and Paediatric examinations.
Part 1
Complete all mother’s and baby/child’s details at the top of Page 1.
Part 1 ensures parents understand the consent process and can ask questions. Please answer any questions parents may have. Complete the parent name clearly.
Part 2
After having read the Information for families brochure and/or watching the Post-mortem service overview video, parents are to select 1 of the 3 post-mortem options by filling in part 2a for an external examination, 2b for a full examination or 2c for a limited examination.
Genetic testing is a very important and each examination type has the option for parents to consent to genetic testing or metabolic studies by ticking the ‘yes’ box. If consenting to genetic studies only, parents are to complete section 2c2.
If parents opt for a limited post-mortem section 2c1 should be completed. They must specify which area of the body they wish to limit the post-mortem to by ticking the appropriate box (show part 2c1).
Part 3
It is routine practice for all organs to be returned to the body at the completion of the post-mortem. However, in certain circumstances, it is helpful for an organ or organs to be retained for a period (such as the brain, for up to 2 weeks) to allow for detailed examination. You may have already discussed this possibility with the pathologist, or a pathologist may approach you with this request. If applicable, parents stated their permission for retaining, disposing and use of the organs removed.
Part 4
Parents must sign and date this section for the consent to be valid.
Part 5
Please indicate the date and time of funeral arrangements, if known.
Part 6
The Senior Clinician obtaining and witnessing parental consent must complete all fields in Part 6. A tick box is available for verbal consent and must be ticked where parental verbal consent is obtained in lieu of written consent.
Part 7
A copy of the post-mortem report will be sent to this consultant to ensure all results are acted on. The examination cannot proceed without this section being completed. The named person can be the same as in part 6.
Part 8
In addition to the named consultant provided in part 7, list any Doctors or Clinicians who require a copy of the post-mortem report. A plain language report can also be requested in this section. Please note that reports are never sent directly to parents.
Part 9
This section provides guidance on the correct form to complete for clinical information.
Parts 10, 11 and 12 are to be left blank and are completed by PathWest staff
NCC Form 2A, 2B and 2C
For the second part of the consent process the clinical information needs to be completed. There are 3 different forms based on the age of the baby or child.
Complete form NCC2A for all miscarriages, fetal deaths and stillbirths regardless of gestational age.
Complete form NCC2B for all neonatal deaths up to 28 days of life, or infant deaths up to one year of life.
Complete form NCC2C for all paediatric deaths over 1 year, up to 18 years of life.
Each form must include the mother’s or child’s details – please ensure this matches the details provided on NCC Form 1.
Complete the relevant clinical history of the mother or child, providing as much information as possible. Attach any ultrasound reports, or other relevant results.
Original forms are to be given to the Perinatal Pathology department.
Yes, PathWest can cremate babies less than 28 weeks gestation at PathWest KEMH/WNHS. Advice about funerals can be provided by social work or pastoral care services.
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 documentation has been received. There are two options to choose from:
A: Interment of Ashes Service
The KEMH/WNHS Interment of Ashes Service is a Memorial Service where the ashes (cremated remains) of stillborn babies, up to 27 weeks and 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 and details of the service are sent to parents.
This service is free of charge.
B: Individual cremations
As an alternative to participation in the KEMH Interment of Ashes Service, PathWest can perform individual cremations and return ashes to the parent(s) for stillborn babies less than 28 weeks gestation. Parental consent applies.
This service is also offered to private hospitals that have a contract with Perinatal Pathology. A fee applies.
Parents have a choice of how they would like to collect their baby’s ashes which must be clearly indicated on the cremation consent form (Form NCC3) by ticking the appropriate option. Ashes cannot be posted to a home address. 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.
The law allows the use of tissue for other purposes such as research, training and education, and quality assurance purposes.
For example, researchers may wish to study post-mortem tissue. Consent to allow tissue to be available for ethical research, or other purposes, can be given with the post-mortem consent process. It is important to note that all research must be approved by the hospital ethics team, and that all tissue will be deidentified, ensuring protection parent’s and baby’s identity.
If parents do not want their child’s tissue to be used for research, quality assurance or education, please cross out the applicable words in the relevant section of Part 2a, 2b or 2c.
The pathologist writes a detailed report, listing the findings made and results of any additional investigations. The preliminary report containing information obtained from the visual 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 6 to 8 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.
The post-mortem report is a complex medical document. It is necessary that these findings are discussed with a medical practitioner to have the findings explained and any questions answered. It may also be appropriate to plan a further care pathway.
Yes, it is possible for parents to see and hold their baby after a post-mortem examination if they would like to. More information about creating memories is available on the Information for Families page. If any incisions are made these are repaired after the post-mortem procedure and are not visible when baby is dressed.
A set of clinical photographs are taken for every post-mortem. These photographs may be shared with other treating clinicians. Perinatal staff also take social photographs and hand and footprints that can be taken home by parents provided there is consent. All mementos prepared by PathWest are stored indefinitely and are available upon request.
Forms required
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.
Collecting 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/Viewing
The Perinatal Pathology facilities at KEMH/WNHS 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 or email perinatal.pathology@health.wa.gov.au. 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 non-technical language. These reports 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 Stillbirth Education Video Series: Baby and placenta preparation (youtube.com)
PathWest Stillbirth Education Video Series: Transport (youtube.com)
PathWest Perinatal Pathology provides a statewide 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
Please see the education video links above.
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.
- All documentation must accompany baby during transport. If a baby is for a post-mortem examination or Perinatal Pathology cremation, then the appropriate documentation indicating consent must also be provided.
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 and email this to Perinatal Pathology prior to transport.
- 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 be discussed with you by your treating doctor.