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We thank Dr Pinheiro for his interest in our recent article, which demonstrated a significant reduction in rates of intrapartum fetal death over 25 years in 3 tertiary-level institutions. 1,2 He questioned the apparent sudden shift in overall death rates and hypoxia-related deaths, occurring in 1987-1988. The sudden drop in uptake of perinatal autopsy from 2002 onward is also highlighted.</P>The abrupt change in parental uptake of autopsy is easily explained. In 2000 it was revealed that a large UK hospital had engaged in unauthorized removal and retention of organs at autopsy, including perinatal autopsy, over a 7-year period. 3 Although this policy was unrelated to our institutions in Dublin, Ireland, it nonetheless received widespread media attention and led to a general loss of public confidence in autopsy practice in the United Kingdom and Ireland. Following this, the rate of postmortem uptake after intrapartum stillbirth in our units fell from 100% in 2001 to 0% in 2002, albeit with very small numbers in absolute terms (1 and 3 deaths, respectively).</P>However, we are unaware of an obvious cause underlying the sudden shifts between 1987 and 1988. Although the rate of fetal death in 1987 (18 of 18,792; 0.96 per 1000 births) was increased, compared with the previous year (12 of 19,221; 0.62 per 1000 births), this rise was not statistically significant ( P = .2763). There does appear to be a sudden fall in intrapartum stillbirths in 1988, however. Two of our units recorded no intrapartum fetal deaths in 1988, although there were no clearly identifiable changes in clinical policy or care structure at that time, as Dr. Pinheiro suggests. As such, although we are happy to clarify the abrupt fall in uptake of perinatal autopsy, an obvious reason underlying the shifts in 1987-1988 is more elusive.</P> http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png American Journal of Obstetrics and Gynecology Elsevier
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