Postnatal Investigation
The guidelines recommend management of common obstetric conditions at primary and referral level, based on local experience and evidence-based practice. They are not intended as strict protocols nor as standard operating procedures, but rather as a guide to safe effective management of common obstetric problems. The guidelines should be most useful to interns, medical officers and registrars.
Procedure for perinatal autopsy
List of some well known and possible teratogens
Where a genetic condition or birth defect is suspected, the following steps should be followed to obtain a diagnosis so that appropriate postnatal counseling may be provided about risks of recurrence of the condition in a future pregnancy.
History and basic external examination
- Obtain a full pregnancy history, including possible exposure to teratogens
- Obtain a full family history
- Note whether there was oligohydramnios or polyhydramnios
- Record head circumference, weight, length, right foot length, & all abnormal external clinical features
- With parental consent, take photographs to show all the clinical features
Special investigations
- Check or repeat syphilis serology (RPR)
- Do a full body x-ray (babygram)
- Send blood for karyotyping & other tests as clinically indicated
Extended investigations (when necessary) for a stillborn baby
- Investigate as above (RPR, photographs, babygram)
- Consider Kleihauer test, Rh group & Coomb’s test, & diabetes screening
- For a fresh stillbirth, take heparinised blood from the heart & send for karyotyping
- In addition, or alternatively, remove a piece of full-thickness skin from the baby’s popliteal fossa, place it in sterile saline, and ensure it reaches the laboratory within 48 hours for karyotyping
- If possible, request an autopsy for suspected cardiac & renal disorders, and for congenital anomaly syndromes
PROCEDURE FOR PERINATAL AUTOPSY
- Inform the mother or parents & nursing staff about plans for autopsy
- Send aborted fetuses (<500 g) with their placentas to the laboratory in sterile saline (not for autopsy)
- Put a 3X3 cm piece of placenta in formalin & send it for histology. Indicate on the slip that the baby is also being sent for autopsy. Send another piece of placenta in sterile saline for MCS
- Complete an autopsy consent form with the mother (if she agrees)
- Complete separate hospital & laboratory autopsy request forms
- Contact the pathology registrar on call to arrange any further details
- Take all completed forms to the mortuary
- Arrange a follow-up date (± 1 month) for the mother or parents
LIST OF SOME WELL KNOWN & POSSIBLE TERATOGENS
Maternal infections
- Syphilis
- Toxoplasmosis
- Rubella
- Cytomegalovirus
- Human parovirus B19
- Herpes simplex virus
Maternal medical conditions
- Diabtes melliuts
- Epilepsy
- Hypo-and hyperthyroidism
- Systemic lupus erythematosus
- Phenylketonuria
Drugs/chemicals/rediation
- Recreational drugs: Ethyl alcohol, cocaine
- Warfarin, Ergomatine, Lithium, Retinoids
- Anticonvulsants: phenytoin, valproic acid
- Antineoplastic drugs: methotrexate, cyclophosphamide, aminopterin
- Antibiotics: tetracycline, kanamycin, streptomycin
- X-ray radiation in large doses
- heavy metals: mercury, lead