Abstract
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.
Highlights
Maternal mortality is an important public health problem with socioeconomic and clinical components
The major complications that account for nearly 75% of all maternal deaths are severe hemorrhage, infections, hypertensive disorders of pregnancy, complications from delivery, and unsafe abortion
The Turkish Statistical Institute (TURKSTAT) has been collecting data on the number of deaths and causes of death using the vital registration (VR) system since 2009 in details of ICD-10 codes, and underlying cause is the main concern as the World Health Organization suggests
Summary
Maternal mortality is an important public health problem with socioeconomic and clinical components. The annual number of maternal deaths decreased by 43% from approximately 532,000 in 1990 to an estimated 303,000 in 2015 (1). By 2030, every country should reduce its maternal mortality ratio (MMR) by at least two thirds from the 2010 baseline, and no country should have an MMR higher than 140 deaths per 100,000 live births (2). The major complications that account for nearly 75% of all maternal deaths are severe hemorrhage, infections, hypertensive disorders of pregnancy, complications from delivery, and unsafe abortion. Many maternal deaths are still not identified (2). Accurate determination of causes of maternal deaths is critical for effective prevention. Autopsy remains the gold standard evaluation for maternal deaths. Our aim was to evaluate maternal death autopsies in a fiveyear period in Turkey
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