Birth Details
Birthdate
Time of birth
Sex
Weight
Death details
Date of death
Time of death
Date of autopsy
Autopsy performance
Autopsy type
Limitations?
Pathologist
Physician notified
Maternal History
Maternal age
Gravida/Para
G:
P:
A:
Prenatal Labs
Blood type
Ab screen
RPR
HepB
HIV
Rubella
GBS
Labor information
Prenatal ultrasound (if known)
Date of sonograph
Findings
Labor details
Describe the hospital course
Hospital course
Choose age to use for reference data
| Fetal weights (grams) | Fetal measurements | ||
|---|---|---|---|
| Body | Crown-heel | ||
| Heart | Crown-rump | ||
| R Lung | Head circ | ||
| L Lung | Chest circ | ||
| Liver | Abdomen circ | ||
| R Kidney | Foot length | ||
| L Kidney | Inner canthal dist | ||
| R Adrenal | Outer canthal dist | ||
| L Adrenal | Pupil diamter (mm) | ||
| Gonads (cm) | Heart - TV circ | ||
| Thymus | Heart - PV circ | ||
| Spleen | Heart - MV circ | ||
| Brain | Heart - AV circ | ||
| Placenta | RV thickness | ||
| LV thickness |
General Body
Habitus
Skin / Soft tissue
Extremities
*Meconium staining
Medical intervensions
Head and Neck
Head shape
Fontanelles
Eye color
Sclera/Conjunctiva
Pupils
Oral cavity
Hair
Abdomen & Perineum
Abdomen
Umbilicus
External genitalia
Anus
Body cavities and in-situ exam
Incision
Subcutaneous fat
Peritoneal cavity
Diaphragm
Abdominal organs
Internal genitalia
Pleural cavities
Right pleural fluid
Right pleural fluid
Mediastinum
Great vessels
Pericardium
Scalp
Cranium/Meninges/Dura
Tissues for ancillary testing
Microbiology
Blood culture
Snap frozen
Cytogentics
Electron microscopy
Organ systems
Cardiovascular system
Heart size
Pulmonary venous return
Atrial septum
Ventricle septum
Ventricles
Endocardium
Coronaries
Aortic outflow
Pulmonary outflow
Surgical interventions
Pulmonary system
Airways
Right lung
Left lung
Parenchymal vessels
Gastrointestinal system
Esophagus
Stomach
Stomach contents
Pylorus
Small intestine
Small intestine contents
Appendix
Colo-rectal
Colo-rectal contents
Hepatobiliary system
Liver shape
Liver parenchyma
Hepatic veins
Gallbladder
Extra-hepatic Biliary tree
Other hepatic findings
Genitourinary system
Cortical surface
Kidney parenchyma
Ureters
Bladder
Other GU findings
Reproductive system
Testes
Prostate
Other reproductive findings
Hematolymphoid system
Thymus
Spleen
Bone marrow
Lymph nodes
Other findings
Endocrine system
Thyroid
Parathyroids
Adrenals
Pituitary
Other endocrine
Skin and Musculoskeletal system
Skin
Muscle tissue
Bones and cartilage
X-Rays
Nervous system
Duration of fixation (days)
Development stage
Brain surface
Cranial nerves + basal vessels
Cerebral cortex
Ventricles
Cerebellum
Brainstem
Spinal cord
Other CNS findings
Cassette summary
| Cassette # | Label |
|---|---|
Lung || Heart || GI
Lung Micros:
Heart / CV Micros:
GI micros:
Liver || GU || Heme
Hepatobiliary micros:
Genitourinary micros:
Hematolymphatic micros:
Endo || MSK || CNS || Placenta
Endocrine micros:
Musculoskeletal micros:
CNS micros:
Placenta micro:
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