Prenatal deaths are categorized as:

1. Products of Conception: As defined by law, "products of conception" means any tissues or fluids, placenta, umbilical cord, or other uterine contents resulting from a pregnancy. Products of conception do not include fetus or fetal body parts.
2. Fetus: The stage of prenatal development that starts 8 weeks after fertilization and lasts until the end of pregnancy.
3. Stillborn: Equal to or greater than 20 weeks gestation, defined clinically by ultrasound measurements, by date of last menses, and greater than or equal to 400 grams in weight.
4. Fetal Remains: As defined by law, "fetal remains", means a dead fetus or part of a dead fetus that has completed at least 10 weeks of gestation or has reached the stage of development that, upon visual inspection of the fetus or part of the fetus, the head, torso, or extremities appear to be supported by skeletal or cartilaginous structures. Fetal remains do not include the umbilical cord or placenta.

For Products of Conception: The completed forms are required from the responsible staff obstetrician, or emergency room physician, or mid-level practitioner to accompany the specimen to surgical pathology:

1. Epic generated Specimen Requisition form for surgical specimen exam, including clinical information from obstetric or emergency room department.
2. Provided there are no fetal remains supported by cartilaginous or skeletal structures, the case will be handled by pathology as a routine surgical specimen.

Due to the increased probability of encountering fetal remains supported by skeletal or cartilaginous structures during pathologic examination, cases being sent to surgical pathology treating a suspected fetal demise regardless of gestational age: The following completed forms are required from the responsible staff obstetrician, emergency room physician, or mid-level practitioner to accompany the specimen to surgical pathology:

1. Epic generated Specimen Requisition form for surgical specimen exam, including clinical information from obstetric or emergency room department recording clinical determination of the embryo's estimated gestational age and weight at presentation.
2. When fetal remains are identified, an external examination only is to be performed on that portion of the case requiring the following additional forms:
1. Final Disposition of Still Birth (State of Michigan Final Disposition of Stillbirth Form DCH-0490/Green form sample) filled out by the physician or RN and signed by the mother of the fetus designating her choice of final burial to be handled by HFHS or other mortuary service of her selection.
2. Epic generated Disposition of Body form (HFHS-01-0291-MR-0215)
3. If cytogenetic testing is requested, in addition to the forms above, please include:
1. Autopsy Permit and Consultation form (e-HFHS-86-0916)
1. Note: The inclusion of this form does not indicate an autopsy will be performed.  This form is required in the event there is no placenta or umbilical cord tissue to sample, necessitating a skin sample to be collected directly from the fetus.

For Stillborn autopsies: Completed forms required are:

1. Epic generated Disposition of Body form (HFHS-01-0291-MR-0215)
2. Autopsy Permit and Consultation form (HFHS-86-8160-MR-0215)
3. Final Disposition of Still Birth (State of Michigan Final Disposition of Stillbirth Form DCH-0490/Green form sample) filled out by the physician and signed by the mother.
4. For stillborn fetus: Certificate of Fetus Born Dead (DCH-0483) or Report of Fetal Death form (DCH-0615S) must also be completed (refer to Tier I HFHS Fetal Demise/Neonatal Demise Policy).

For a Live Birth, regardles of the subsequent duration of life, a medical record number must be issued, along with a certificate of live birth and certificate of death. Please also attach clicnial documentation from the obstetrical or emergency record that must include clinical determination of the fetus's gestational age and weight at presentation. The procedure is the same as for an adult autopsy, and the forms required are:

1. Epic generated Disposition of Body form (HFHS-01-0291-MR-0215)
2. Autopsy Permit and Consultation form (HFHS-86-8160-MR-0215)