Maternal mortality due to valvular heart disease: a population-based study in Turkey.

BACKGROUND/AIM: To assess the clinical and demographic features of maternal mortality cases among patients with cardiac valvular diseases between 2012 and 2019. METHODS: Maternal mortality due to valvular heart disease between January 2012 and December 2019 in Turkey was retrospectively analyzed. The cases were classified according to New York Heart Association (NYHA) classification based on the severity of the heart disease. NYHA classification groups were divided into two; as class I-II (n = 34) and class III-IV (n = 31). Two groups were compared in terms of demographic and clinical characteristics. RESULTS: Valvular heart disease was diagnosed in 41 (63.1%) of the cases before pregnancy. It was found that 100% (n = 21) of the warfarin users had switched to low molecular weight heparin treatment due to concerns about warfarin embryopathy after the diagnosis of pregnancy, and only 14.2% (n = 3) of them had been monitorized with Antifactor Xa activity to evaluate the effectiveness of the medication. Two NYHA groups had similar clinical characteristics. Intensive care unit admission rate, frequency of prosthetic valve, rate of thromboprophylaxis, type of valvular disease and reasons of maternal death were similar between the NYHA groups (p < 0.05). CONCLUSION: Maternal mortality may be observed in cases with NYHA class I-II in almost similar rates with NYHA class III-IV. Therefore, it is crucial to adequately assess the mortality risk of pregnant women with cardiac valvular pathologies and to achieve early diagnosis and appropriate treatment in order to reduce maternal mortality.

Maternal deaths with epilepsy: A population-based study in Turkey.

OBJECTIVE: To evaluate the clinical characteristics of maternal deaths with epilepsy in Turkey. STUDY DESIGN: This epidemiological population-based study was conducted on all consecutive early maternal deaths with epilepsy in Turkey from 2012 to 2019. Maternal deaths accompanied by epilepsy as a comorbidity (n = 13) were evaluated separately. Epilepsy related maternal deaths were divided into two groups: 1) status epilepticus (n = 19) and 2) Sudden unexpected death in epilepsy (n = 19). Two groups were compared in terms of demographic features and clinical characteristics. RESULTS: Maternal deaths with epilepsy ranged between 2.5 % and 5.3 % among total maternal deaths. Pulmonary embolism (32 %), cerebrovascular event (23 %), and cerebral vein thrombosis (15.4 %) were the leading mortality reasons in maternal deaths accompanied by epilepsy. Epilepsy duration, the time interval between pregnancy and the last epileptic seizure, compatibility with medication, rates of preconceptional counseling, and regular antenatal follow-up were all significantly higher in the sudden unexpected death in epilepsy group. The perinatal complication rate was significantly higher in the status epilepticus group (p > 0.05). CONCLUSION: Physicians who deal with pregnant women with epilepsy should be attentive for severe complications and the increased risk of maternal mortality in these cases should be kept in mind.

Changing trends in the Turkish maternal deaths, with a focus on direct and indirect causes.

OBJECTIVE: Our aim is to evaluate trends in the direct and indirect causes' distribution using data from National Maternal Mortality Surveillance (2012-2015). STUDY DESIGN: A population-based retrospective review was performed on all pregnancy-associated maternal deaths in Turkey from 2012 to 2015. Causes of death were grouped into direct and indirect maternal deaths and compared in the context of distribution. Maternal mortality rate was reported. Statistics included chi-square test or Fisher's exact test for categorical variables. RESULTS: Between 2012 and 2015 there were 812 maternal deaths. The maternal mortality rate was 15.4 deaths per 100,000 live births in 2012 as compared to 13.7 in 2015. Direct maternal deaths in Turkey declined from 59.5% in 2012 to 45% in 2015 while indirect maternal deaths increased from 45% in 2012 to 55% in 2015 (p = 0.045). The leading direct causes of maternal deaths were postpartum hemorrhage. The major indirect causes of maternal deaths were circulatory system diseases. CONCLUSION: Direct maternal deaths in Turkey appear to be declining. This data will aid the management of maternal deaths.

The value of autopsy to determine the cause of maternal deaths in Turkey

Objective: To analyze the value of autopsy reports for determining the cause of maternal deaths in Turkey. Material and Methods: In this descriptive retrospective study, the case files of 992 maternal deaths, except for accidental causes, that occurred in Turkey between 2012 and 2016 were reviewed. An autopsy examination was performed in 177 (17.8%) of the cohort. When the files were reviewed, maternal descriptive data and the cause of maternal mortality according to the autopsy reports were recorded. Results: The mean age at death was 31.5±6.6 years. No exact cause of maternal death was identified after autopsy in 44 (24.9%) of the 177 cases. An exact cause of death could be determined in 133 (75.1%); 34.5% (n=61) were due to direct causes, and 40.7% (n=72) were due to indirect causes. The leading direct causes of maternal deaths were obstetric hemorrhage (13.0%) and obstetric (pulmonary and amniotic fluid) embolism (12.4%). The main cause among the indirect causes was ruptured aortic aneurysm and/or dissection of aorta (8.5%). Among the subjects with no clinical diagnosis based on the clinical course before death (n=96), the exact cause of death could not be determined at autopsy in 19 (19.8%) cases. The exact or possible cause of death was identified at autopsy in 80.3% (n=77) cases with no clinical diagnosis. Among the cases who had antemortem diagnoses based on the clinical course (n=81), the final diagnosis at autopsy was compatible with the clinical diagnosis in 48 (59.3%) subjects. Conclusion: Maternal autopsy examination provides an exact cause of death in most cases and is still a valuable tool for understanding the cause of maternal mortality.

Maternal mortality cases from pulmonary embolism: A nation-wide study in Turkey.

The aim of the study was to evaluate the maternal mortality cases attributed to pulmonary embolism (PE). PE constituted 7.58% of maternal deaths in 2013. Risk factors for PE were present in 15 (88.2%) of the women. Five women (29.4%) were overweight, and 5 (29.4%) were obese. Four women (23.5%) had cardiac diseases. PE occurred in the postpartum period after caesarean delivery in 9 (52.9%) patients. Eleven (64.7%) of the maternal deaths were recognised as preventable. More deaths attributed to PE occurred in the postpartum period (n = 11) than the antepartum period (n = 5). One other maternal mortality case was after therapeutic abortion. Caesarean section, obesity and cardiac diseases were important risk factors. It can be suggested that monitoring all risk factors and timely recognition of related symptoms and signs with initiation of appropriate management have paramount importance for reducing maternal mortality rate related to pulmonary embolism. Increasing awareness of healthcare professionals as well as the public, and continuously reviewing the cases are also important tools for achieving this goal.