Stillbirth investigation with post-mortem MRI

The Royal Australian and New Zealand College of Radiologists [RANZCR] is supporting clinical radiologists to help reduce the rate of stillbirth in Australia by 20% over the next five years. Stillbirth investigations are fundamental to stillbirth prevention. Offering a non-invasive alternative, such as MRI, as an addition to or substitute for autopsy, when the latter is refused by parents, may mean more stillbirths will receive investigation.

Six stillbirths occur every day in Australia, accounting for 7.7 of every 1000 registered Australian births in 2020. Up to 22% of stillbirths are recorded as unexplained following extensive investigations.

No two stillbirths are the same. Accordingly, a tailored approach to stillbirth investigation is needed. Post-mortem imaging is a vital part of contemporary stillbirth investigation and clinical radiologists are well placed to provide this service. RANZCR in partnership with the Department of Health and Aged Care (DoHAC) is committed to supporting clinical radiologists to take their place in the clinical team that helps families to understand “why?”.

Autopsy conducted by a perinatal pathologist is considered the reference standard investigation for determining the cause of death following stillbirth. However, the National Stillbirth Action and Implementation Plan identified a national shortage of perinatal pathologists in Australia. Consequent long delays in providing autopsy reports to families have been identified as a major source of distress for bereaved parents.

Additionally, most parents of a stillborn baby refuse conventional autopsy when this is offered to them, with less than 25% of Australian stillbirths being investigated with conventional full autopsy. Scientific evidence supports the accuracy of post mortem MRI following stillbirth and neonatal death as part of a “minimally invasive” autopsy.

Recognising the important role of medical imaging in 21st century stillbirth investigation, the DoH provided funding to RANZCR in the May 2021 Federal Budget as part of the National Stillbirth Action and Implementation Plan, to improve professional capacity to provide imaging - based stillbirth investigations.

Within the first 2 years of a 3 ½ year program of work, RANZCR has produced a training package, including best practice standards/guidelines for stillbirth imaging investigation (in collaboration with the NHMRC Stillbirth Centre for Research Excellence who are leading the Care After Stillbirth and Neonatal Death Guideline project); practice support resources; decision support tools; and enabled interdisciplinary collaboration to grow. Other highlights of the training package include a series of six educational webinars that were provided by international experts in perinatal post-mortem imaging, with training culminating in an advanced two-day course and symposium in Melbourne August 4 and 5 2023 featuring international and local experts in post-mortem imaging, parent advocacy groups, stillbirth research, and perinatal pathology as well as Australian Government representatives.