Perinatal pathology: current practice and hopes for the future

Perinatal pathology: current practice and hopes for the future

Daniel Nuzum (1), Brendan Fitzgerald (3), Keelin O’Donoghue (1,4), Margaret Jane Evans (2)

(1) Department of Obstetrics and Gynaecology, University College Cork, Cork University Maternity Hospital, Wilton, Cork, Ireland; (2) Department of Pathology, Edinburgh Royal Infirmary, Edinburgh, Scotland; (3) Department of Pathology, Cork University Hospital, Wilton, Cork, Ireland; (4) Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Cork, Ireland.

Introduction:
Post-mortem and placental examination provides valuable information regarding cause of death following stillbirth and neonatal deaths but what are the difficulties facing the specialty? Objectives:
This study examined the current practice and challenges facing consultant perinatal pathologists.

Methods:
Voluntary, anonymised online questionnaire-based study of consultant paediatric/perinatal pathologists (UK and Ireland).

Results:
Thirty consultants responded (44% of total registered with EQA scheme). 6 (20%) gave an incorrect answer regarding the frequency of stillbirth. 23 (73%) had been working for 10 years or more. 23 worked in split posts: 17 (56%) paediatric and perinatal and 6 (20%) split with adult pathology. 9 (31%) felt that paediatric and perinatal pathology posts should be separate. Reasons for entering the specialty included availability of jobs (10), inspiring consultant (12) and personal interest (18). 20 (69%) had received negative comments. 15 (50%) felt that consultants should be involved in autopsy consent and 7 (24%) met parents to discuss the autopsy. In the last 5 years, 12 (40%) had never been asked to see the parents. 17 (58%) stated that clinicians never attended the autopsy though 15 (50%) felt that they should. 11 (38%) saw parents with clinicians to discuss the findings and ten (37%) would have liked to but had no time. 15 (52%) provided a “plain English” report on request. 29 (97%) felt pathologists should be involved in the review process with protected time for this. 15 (50%) were involved in bereavement training and 29 (96%) were happy to be contacted by a chaplain to discuss faith specific issues. 20 (69%) felt training in bereavement counselling and resilience was appropriate for those undertaking autopsies but only 4 (14%) had been offered training in bereavement and 5 (17%) in resilience. All surveyed would encourage trainees to follow their path. 18 had trainees in post.

Discussion:
The study outlined lack of time for trainees, parents and participation in perinatal mortality and morbidity reviews and a need for bereavement counselling and resilience training. Protected time is required in contracts to allow for extended roles. It is noteworthy that all would encourage trainees to enter the discipline despite having faced negative comments.

Ethics statement:
Ethical approval for this study was granted by the Clinical Research Ethics Committee of the Cork Teaching Hospitals (Ref No: ECM4(a) 07/03/18)

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