An autopsy study of maternal mortality: a tertiary healthcare perspective.

ABSTRACT

BACKGROUND: An audit of autopsies of maternal deaths is important for the establishment of accurate cause of maternal deaths and to determine the contribution of various etiologies responsible in a given community. AIM: To study the causes of maternal deaths as determined by a pathological autopsy. SETTINGS AND DESIGN: A retrospective study of all the cases of maternal deaths that underwent a pathological autopsy in a tertiary healthcare center from January 1998 to December 2006. MATERIALS AND METHODS: The autopsy records with clinical notes were retrieved; gross and histopathology specimens and slides were studied to establish the accurate cause of maternal deaths. The variables like age (years), stay in the hospital, gravidity, trimester of pregnancy and method of delivery were used to classify and analyze the data from the autopsies. The causes of maternal deaths were divided in to direct and indirect; each being classified into subgroups based on the most evident pathology on autopsy. RESULTS: The Maternal Mortality Rate (MMR) over a nine-year period (1998-2006) was 827/100000 live births (471 maternal deaths against 56944 live births). An autopsy was performed in 277 cases (58.8%). In the autopsy group, the most common causes of maternal mortality were pre-ecclampsia/ecclampsia (40 of 277, 14.44%) and hemorrhage (32 of 277; 11.55%); However, indirect causes like infectious diseases (27 of 277; 9.75%) and cardiac (27 of 277; 9.75%) disease also contributed to maternal deaths. CONCLUSION: Indirect causes like rheumatic heart disease and infections like tuberculosis, malaria or leptospirosis and nutritional anemia are still major causes of maternal mortality in developing countries like India. Intensive efforts need to be taken in these areas to reduce the maternal mortality in developing countries like India.