Diabetes in pregnancy: are we providing the best care ... - HQIP

was no information available to panels as to why the postmortem examination was not carried out despite
being offered. In one case only external examination was performed, and for one case it was documented
in the medical records that postmortem examination was not needed. Overall, 45% (62/137) of babies who
died were documented to have had a postmortem examination, which is slightly higher than the national
average of 40% in 2002-03. 5
Postmortem examination fi ndings were available to the panel for 57 out of 62 babies and are reported in
table 5.7. The reported incidence of islet cell hyperplasia and eosinophilic infi ltrates in the pancreas was
lower in this group of babies than in previous reports. 6 It is diffi cult to be certain of the reasons for this
difference, but possibilities include under-reporting due to advanced autolysis, a particular problem
in the pancreas.
Table 5.7
Postmortem examination fi ndings in babies who died after 20 weeks gestation having a postmortem
Specific findings reported n (%)
(N=57)* †
Islet cell hyperplasia 6 (11)
Eosinophilic pancreatitis 1 (2)
Cardiomegaly 10 (18)
Vascular thrombosis 0 (0)
No abnormality reported on postmortem 41 (72)
* 5 postmortem examination reports were not available.
† There may have been more than one fi nding reported for any baby undergoing postmortem examination.
5.4 Conclusions
Women in the enquiry were similar to women in the descriptive study with respect to socio-demographic
characteristics. Due to the sampling methodology for the enquiry (see Chapter 4), half of the women in the
enquiry had a poor pregnancy outcome.
Twelve percent of women in the enquiry had nephropathy and 32% had retinopathy (pre-existing or
diagnosed for the fi rst time in pregnancy). About half of women in the enquiry had recurrent hypoglycaemia
during pregnancy and a fi fth had at least one severe hypoglycaemic episode requiring external help.
Babies with antenatal evidence of fetal growth restriction had a higher proportion of mothers with
nephropathy compared to all babies in the enquiry, and 70% had a poor outcome. Forty one per cent
of babies with antenatal evidence of macrosomia had a poor outcome, which was similar to the 50% of
babies in the whole enquiry sample with a poor outcome.
Sixteen percent of babies who died from 24 weeks of gestation up to 28 days after delivery had a cause
of death classifi ed as ‘severe or lethal congenital anomaly’. Women in the enquiry had a higher proportion
of unexplained antepartum fetal death and a lower proportion of deaths due to immaturity than the general
maternity population. Nearly half of all babies who died had a postmortem examination.
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