Issue date: December 2004

Revised date: June 2013

Review date: June 2018

Authors: Jo Smedley - Bereavement Services Midwife

Anne Walton – Ward Manager, Gynaecology Short Stay Unit
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Title of Guideline (must include the word “Guideline” (not
protocol, policy, procedure etc) Guideline for the Management and Disposal of
Fetal remains and Products of Conception

Contact Name and Job Title (author)

Jo Smedley
Anne Walton

Directorate & Speciality

Gynaecology and Cellular Pathology.
Family Health

Date of submission
June 2013

Date on which guideline must be reviewed (this should be one to

three years) June 2018

Explicit definition of patient group to which it applies (e.g.

inclusion and exclusion criteria, diagnosis) All patients who have a miscarriage, ectopic
pregnancy or termination of pregnancy

Abstract This guideline describes how Health Care

Professionals involved in the care of women who
have a pregnancy loss will manage and arrange
disposal of fetal remains and products of
conception

Key Words
Miscarriage, fetal remains, products of
conception

Statement of the evidence base of the guideline – has the

guideline been peer reviewed by colleagues? 5 Recommended best practice based on the
clinical experience of the guideline developer
Evidence base: (1-5)
1a meta analysis of randomised controlled trials
1b at least one randomised controlled trial
2a at least one well-designed controlled study without
randomisation
2b at least one other type of well-designed quasi-
experimental study
3 well –designed non-experimental descriptive studies
(ie comparative / correlation and case studies)
4 expert committee reports or opinions and / or clinical
experiences of respected authorities
5 recommended best practise based on the clinical
experience of the guideline developer
Consultation Process
Consultation with Gynaecology medical and
nursing staff, theatre staff, Department of
Spiritual and Pastoral care, Pathology staff

Target audience

This guideline has been registered with the trust. However, clinical guidelines are guidelines only. The
interpretation and application of clinical guidelines will remain the responsibility of the individual clinician. If
in doubt contact a senior colleague or expert. Caution
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date.
 Contents

1. Policy statement

2. Introduction

3. Principles

4. Operational policy

5. Variations to the operational policy

6. References

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1. Policy statement

All fetal remains regardless of gestational age will be handled and disposed of in a sensitive
manner. This will include fetal tissue and products of conception from all surgical procedures
including suspected ectopic pregnancy, natural miscarriage and termination for both medical and
social reasons, either by medical or surgical management and any baby born dead before 24
weeks gestation.

2. Introduction

The Polkinghorne report (1989) acknowledged the special status of the fetus:

“On the basis of its potential to develop into a human being, a fetus is entitled to respect, according
it a status broadly comparable to that of a living person. Thus, the relevant categories of ethical
significance are ‘alive’ and ‘dead’, and the category of ‘pre-viable’, used in the Peel report, is not of
ethical significance.”

Polkinghorne (1989, p.20)

The death of a baby at any gestational age can be a painful and distressing time for the woman
and her family. It is important that the woman’s wishes are adhered to regarding both the
examination and the disposal of any baby who is born dead irrespective of gestational age
(Department of Health 2003). Health professionals must ensure that the woman’s choices are
respected and that any legal requirements are met.

It is important to note therefore that only the woman’s signature is accepted on the consent
forms used for the examination and disposal of fetal remains and products of conception.

A baby born dead after 24 weeks gestation is classed as a stillbirth and a stillbirth certificate will be
issued. These babies are offered an individual funeral which is arranged with the Department of
Spiritual and Pastoral Care and is therefore outside the remit of this policy. Any baby born before
24 weeks gestation, showing signs of life must be treated as a live birth. Therefore, the birth and
death must be registered accordingly and an individual funeral will be offered.

3. Principles

There is no legal requirement to bury or cremate fetal remains or products of conception before 24
weeks gestation. However, it is best practice and is in keeping with guidance and
recommendations published by The Royal College of Nursing (2001), the Institute of Cemetery
and Crematorium Management (2004) and other specialists in this field that all fetal remains and
products of conception are disposed of in a sensitive and ethical manner. Nottingham University
Hospitals NHS Trust upholds these principles and has developed systems to enable the sensitive
disposal of all fetal remains and tissue, irrespective of its origin or whether the woman has agreed
to an examination of the remains.
The overriding principle is that the health care professional supports the woman and her family’s
wishes and that they are given sensitive verbal and written information, which clearly states the
options available so that they can make informed choices about the disposal.

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The guidelines below should be considered when handling all fetuses and products of conception.

 The woman should have choices over what happens to her baby regardless of its gestational
age.

 The type of disposal chosen should be indicated on the correct consent to examination form
for the gestational age of the baby. If the woman has not made a decision at the time the form
is completed this should be clearly stated on the form so that it can be handled correctly at a
later date.

 The Trust and its staff will be sensitive to the woman’s wishes including those who do not want
any involvement. In these cases the woman should be informed of the overriding principle of
sensitive disposal and that her baby will be cremated in accordance with hospital policy.

 When a woman has stated that she does not wish to make a decision regarding the disposal
of her baby, she should be informed that she could enquire about the disposal of her baby in
the future if she wishes.

 Confidentiality is of paramount importance and all documentation relating to the disposal of

fetal tissue is anonymised prior to its release to the funeral directors.

 Sensitive written information is available to the woman and her family which will be given to
her around the time that the examination and disposal of the baby are discussed by staff.

 The policy and procedures for the handling of fetuses and products of conception are
available to all staff involved in the care of the woman and her baby.

 Staff will provide support and advice to women and their family, ensuring that time is given to
discuss both the practical and emotional aspects of the loss.

 All women whose babies are delivered on the gynaecology wards will be
offered support by the gynaecology nurses.
 The midwifery staff both in the hospital and the community will support all
women whose babies are delivered on the labour suite.
 All women and their families can access pastoral advice and support from the
Department of Spiritual and Pastoral Care. This department also has a multi-
faith officer and Chaplains from other religions who can give support if required.

 Most fetuses and products of conception are stored in the Paediatric Pathology Department
and the Paediatric Pathology Team handle both their examination and disposal. However,
some babies, usually those who are delivered at around 22-24 weeks gestation on the labour
suite, are transferred directly to the mortuary. A correctly completed consent form must
accompany all babies and products of conception. This is irrespective of whether consent for
an examination has been given. This is so that the Paediatric Pathology Team is aware of the
type of disposal that the woman has chosen and can fulfil their wishes accordingly.

 A senior member of the Bereavement team or the Paediatric pathology team will deal with any
problems relating to the consent form or the disposal of any baby or products of conception for
Paediatric Pathology and Gynaecology Pathology Team.

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4. Operational policy

Many departments across the Trust are involved in this field and all must work together to offer a
high standard of care. Communication and the documentation regarding the woman and her baby
must be clear, accurate and sensitive. Each department has an area of responsibility in this field
and there are policies, guidelines and procedural documents in each area to support and guide
staff.

The general responsibilities of each department are outlined below:

 Nursing and Medical staff.

I. All discussions with the woman regarding the examination of the fetus or products of
conception and their wishes for the disposal should be fully documented in the
medical and nursing notes. This should also include whether written information has
been given.
II. The relevant copy of the consent form should be placed in the medical records
irrespective of whether consent has been given to examine the fetus or products of
conception, as this verifies the choice of disposal.
III. The patient copy of the consent form must always be given to the woman so that she
has a record of the choices she has made. This copy of the consent form also has
relevant contact details on the reverse.
IV. The fetus or products of conception will be prepared in accordance with hospital
policy and transferred to the Paediatric Pathology Department with the top copy of the
consent form. In some cases the baby may be transferred straight to the mortuary, in
these cases the top copy of the consent form must also accompany the baby.
V. The support of the Department of Spiritual and Pastoral Care should be considered
for all women and their families.
VI. If a woman wishes to take her products of conception or fetal remains home with her
she must be allowed to do this and they should be given to her in a dry pot. A consent
form is not required but the Nurse must document this in the nursing documentation.
A certificate of fetal remains MUST be issued to the family with the remains.

 The Gynaecology Short Stay Unit

I. The GSSU team’s role is to support the woman in all aspects of her pregnancy loss.
They offer both practical and emotional support and they assist the Paediatric
pathology team by helping to deal with problems that may arise with the consenting
process and consent forms.
II. The team also work with the Department of Spiritual and Pastoral Care and the
Paediatric pathology team to improve service delivery.

 The Department of Spiritual and Pastoral Care.

I. The Senior Chaplain is responsible for negotiating and arranging a contract with a
local funeral director. This contract includes the provision of individual funerals for
neonatal deaths and stillbirths, and the communal cremation or burial of all fetal
remains and products of conception.
II. Where requested a Chaplain will visit the woman and offer whatever spiritual or
emotional support is required. They may also on request provide a naming and
blessing ceremony or other act of remembrance for the family, and further information
or advice regarding funerals and/or services of remembrance.
III. When a hospital cremation/burial is arranged the Paediatric pathology team will
inform the Department of Spiritual and Pastoral Care of the date and request a
Chaplain to perform the service. Those women who wish to be informed of the date of
the cremation/burial will be contacted by letter only. The letters are sent by the
Bereavement Services Team.

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 Theatres
I. When the woman is transferred from the ward to theatres the consent form must sent
with her peri- operative documentation.
II. Following the surgical procedure the products of conception should be placed in
Formaldehyde if they are for histological examination. ALL products of conception must
be transferred to the paediatric pathology department for the arrangement of examination
and/or sensitive disposal.
III. NB. The only exception to this is - If the POC is for CYTOGENETIC examination, the
POC should be placed in normal saline and sent with the consent form to the
AUTOCORE which is situated near the blood bank at the QMC campus. They will then
send this to cytogenetics at the City campus. (Do NOT send to Paediatric Pathology).
The cytogenetic department will then send the specimen back to the Paediatric Pathology
department for histological examination.

 Paediatric Pathology Team.

I. All products of conception/fetal remains are examined in the Cellular Pathology
Department or in the Mortuary where indicated.
II. The consent forms which accompany the products of conception/fetal remains are
scrutinised by designated members of the team.
III. Each consent form must have been signed correctly and both the consent or refusal
of examination and the choice of disposal section must be completed on the form.
IV. If the consent form is completed and the woman has chosen to refuse an
examination, the tissue/fetal remains are stored in accordance with departmental
procedure until the woman’s wishes for disposal of the tissue or baby have been
fulfilled.
V. If the consent form has not been completed correctly the Paediatric Pathology team
will liaise with the Gynaecology Short Stay Unit team to rectify the problems identified.
If the problem is of a more serious nature then the Paediatric Pathology team may
seek the assistance of more senior staff including the Consultant in charge of the
woman’s care.
VI. Once the consent forms are ratified the products of conception/fetal remains are
booked in and the examination is carried out by the Paediatric/Gynae Pathology
team.
VII. All fetuses are examined by the Paediatric pathologists. All fetal remains are
examined by the Gynaecology pathologists.
VIII. Once the examinations are complete a report is prepared and is sent to the
Consultant in charge of the woman’s care. The pathologist will endeavour to ensure
that the report is ready in time for any follow up appointment that the woman may
have so that the results can be discussed at this meeting. This meeting usually takes
place about eight weeks after the pregnancy has ended.
IX. When the examinations are complete all products of conception/fetal remains are
stored in the Histopathology Department or the Mortuary in accordance with
departmental procedure.
X. At regular intervals all products of conception/fetal remains which require hospital
disposal will be prepared as per Standard Operating Procedure.
XI. The collection of a communal casket and the arrangements for the funeral are
arranged with the contract funeral directors. The Department of Spiritual and Pastoral
Care are informed of the date of the funeral in order for a Chaplain to be present.
XII. The paperwork relating to the disposal is anonymised before it is sent to the funeral
directors and patient details and disposal dates etc are kept within the Paediatric
Pathology department.

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 5. Variations to the Operational Policy

I. Opting for a private funeral – If the woman has requested a private funeral a member
of the Bereavement Team will liaise with the relevant staff to help to facilitate the
release of the tissue/fetal remains. However, if a private funeral has been requested
but no contact has been made by the woman to facilitate this after six months, the
Bereavement Team will attempt to contact the woman. However, if all avenues have
been pursued and contact has not been made the tissue/fetal remains will be
disposed of by hospital cremation.

II. Problems with the consent form – Wherever possible every attempt will be made
through the nurses on the GSSU to locate the woman and request that a new consent
be complete. However, occasionally the woman will not be able to be contacted. In
this instance the tissue will be disposed of by hospital cremation after six months. A
record of this will be put onto the external error log database and in the paediatric
pathology records.

6. References

Polkinghorne J. (1989, p20), Review of the guidance on the research use of fetuses and fetal
material. HMSO, London.

Royal College of Nursing (2001) Sensitive Disposal of all Fetal Remains: Guidance for nurses and
midwives, RCN, London.

Department of Health (2003) Families and Post Mortems: A code of practice, HMSO, London.

Institute of Cemetery & Crematorium Management (2004) Policy Document For The Disposal Of
Foetal Remains, ICCM, London.

SANDS (1995) Pregnancy Loss and the Death of a Baby: Guidelines for professional. Revised
edition. SANDS, London.

Royal College of Obstetricians and Gynaecologists (2005) Disposal Following Pregnancy Loss
Before 24 Weeks of Gestation Good Practice No.5, RCOG, London.

Issue date: June 2013

Revised date: May 2013
Review date: June 2018

Authors:
Jo Smedley, Bereavement Services Midwife
Anne Walton, Ward Manger Gynaecology Short Stay Unit

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