Decreasing use of autopsy for stillbirths and infant deaths: missed opportunity

Objective We assessed whether the tendency towards decreasing use of fetal and infant autopsy was associated with a greater proportion of deaths in which the cause is never found. Study Design We computed autopsy rates over time for 13,466 stillbirths and 16,880 infant deaths in Quebec, Canada, 1981-2015. We assessed the proportion of deaths with an undetermined cause and determined the relationship with non-autopsy over time. Result Autopsy rates declined by 29% for stillbirths and 36% for infant deaths during the study. The proportion of non-autopsied cases with an undetermined cause of death increased only for stillbirths, however. Among non-autopsied stillbirths, the risk of having an undetermined cause of death was 1.64 times higher in 2005-2015 compared with 1981-1992 (95% confidence interval 1.25, 2.15). Conclusion Greater use of autopsy has potential to minimize the number of stillbirths with an undetermined cause of death, and may be helpful for prevention.