Diagnostic Yield of Post‐Mortem Fetal Micro‐CT for Central Nervous System Abnormalities

OBJECTIVES: This study demonstrates the central nervous system (CNS) abnormalities detected using fetal post-mortem micro-focus computed tomography (Micro-CT), independent of whether the abnormality contributed to the main diagnosis or cause of death. METHODS: We retrospectively analyzed 1200 whole body post-mortem fetal Micro-CT scans in an unselected consecutive cohort between 2017 and 2024. The following categories for CNS abnormalities were used: enlarged cerebral spinal fluid (CSF) spaces, midline abnormalities, neural tube defects, disorders of neuronal proliferation, neuronal migration, and hindbrain development, and other cranial and facial abnormalities. RESULTS: Overall, 78 individual CNS abnormalities were identified in 62/1200 (5.2%) fetuses. The most common CNS abnormalities were neural tube defects (18/78; 23.1%), ventriculomegaly (16/78; 20.5%), and intracranial hemorrhage (12/78; 15.4%). CNS abnormalities were isolated findings in 27/62 (44%) abnormal cases, and part of a wider spectrum of extra-CNS abnormalities in 35/62 (56%) of cases. The commonest extra-CNS association was musculoskeletal (25/59; 42%). Despite significant maceration causing reduced image quality in 408/1200 (34%) cases, Micro-CT gave diagnostic CNS imaging in all 792/1200 (66%) fetuses with low, mild, or moderate maceration (score below 4). CONCLUSIONS: Post-mortem Micro-CT imaging can identify a wide range of CNS abnormalities following pregnancy loss in early gestation fetuses, even in the presence of maceration.