Maternal mortality: an autopsy audit.
BACKGROUND
The process of audit standardizes protocols in departments and has long-term benefits. Maternal autopsies though routinely performed, deserve a special attention.


OBJECTIVE
This study was carried out to calculate the maternal mortality ratio (MMR) in a tertiary care hospital and to correlate final cause of death with the clinical diagnosis. An audit of maternal autopsies was carried out to evaluate current practices, identify fallacies and suggest corrective measures to rectify them.


METHODS
Eighty-nine autopsies of maternal deaths in the period 2003 to 2007 were studied in detail along with the clinical details.


RESULTS
There were 158 maternal deaths and 13940 live births in this five-year period. Maternal mortality rate was found to be very high (1133/ 100000 live births) in our institution with a high number of complicated referral cases (68/89 cases, 76%). Of the 89 autopsies, acute fulminant viral hepatitis was the commonest cause of indirect maternal deaths (37 cases, 41.5%). This was followed by direct causes like pregnancy-induced hypertension (12 cases, 13.4%) and puerperal sepsis (10 cases, 11.2%). Certain fallacies were noted during the audit process.


CONCLUSIONS
During the audit it was realized that in maternal mortality autopsies, special emphasis should be given to clinicopathologic correlation, microbiological studies, identification of thromboembolic phenomenon and adequate sectioning of relevant organs. We found difficulty in identification of placental bed in the uterus in postpartum autopsies. A systematic approach can help us for better understanding of the pathophysiology of diseases occurring in pregnancy.
Jashnani
K D
KD
Department of Pathology, T N Medical College and B Y L Nair Ch Hospital, Mumbai Central, Mumbai-400 008, India. kusumjash@hotmail.com
Rupani
A B
AB
Wani
R J
RJ
D001344:Autopsy / Q000379:methods / Q000706:statistics & numerical data*; D002423:Cause of Death; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D008428:Maternal Mortality; D008485:Medical Audit; D011247:Pregnancy; D011248:Pregnancy Complications / Q000209:etiology / Q000401:mortality / Q000473:pathology*; D011787:Quality of Health Care; D012017:Referral and Consultation; D012189:Retrospective Studies