ABSTRACT Objective Despite recent recommendations highlighting the importance of fetal autopsy for genetic counseling and recurrence prevention, its uptake has declined. This study aimed to identify factors associated with absence of fetal autopsy from the perception of healthcare professionals (HP). Methods National cross‐sectional online survey among French HPs involved in the management of fetal loss was conducted. An anonymous questionnaire explored demographic characteristics, perceived medical, emotional, organizational and educational barriers to fetal autopsy, as well as potential strategies to improve uptake. Data were analyzed descriptively. Results A total of 125 HP completed the survey. Opinions about estimated rate of fetal autopsy refusal in stillbirth cases ranged from 30% to 40% across institutions. Refusal rates varied according to the clinical context or reaching over 75% in terminations of pregnancy with known genetic diagnosis. Identified barriers were multifactorial, including emotional distress related to grief, religious beliefs, fetal bodily integrity. Organizational issues constraints also played a significant role. Additionally, many respondents reported that insufficient training influenced the absence of fetal autopsy. Conclusion Fetal autopsy refusal is driven by emotional, cultural, informational, and organizational factors according to practitioners' perceptions. The development of less invasive alternatives and improved training in communication and bereavement care may enhance acceptance and support for bereaved couples.
ABSTRACT Fetal intracranial hemorrhage (ICH) is a rare but serious prenatal diagnosis, and counseling affected families remains challenging. In this narrative review, we summarize current evidence on the classification, epidemiology, etiology, diagnosis and neurodevelopmental outcomes of fetal ICH, with a primary focus on intraventricular hemorrhage (IVH) as the most common presentation. The reported incidence of 0.5–1 per 10,000 pregnancies likely underestimates the true burden. Etiologies include fetal‐neonatal alloimmune thrombocytopenia, cerebral small vessel variants, congenital infection, fetal anemia, coagulopathy and twin‐related complications. Nonetheless, a cause is identified in fewer than half of cases even after complete workup, with a genetic etiology found in roughly 30% of fully investigated cases. Detailed neurosonography is the primary diagnostic tool, and fetal MRI is an important adjunct for defining hemorrhage extent, parenchymal injury and posterior fossa involvement. Outcomes vary with hemorrhage grade, location and laterality. Low‐grade IVH generally carries a favorable prognosis, whereas periventricular hemorrhagic infarction carries substantially higher rates of cerebral palsy, shunting and cognitive impairment, particularly when extensive and bilateral. However, prognostic data derive largely from small neonatal cohorts graded with a system not designed for the fetus, which limits individualized counseling. We propose a practical, fetal‐specific framework built on systematic evaluation, an interdisciplinary team approach and transparent communication about prognostic uncertainty. [Correction added on 26 October 2026, after first online publication: The abstract has been replaced with a revised version.]
