title: Maternal death analysis from the Japanese autopsy registry for recent 16 years: significance of amniotic fluid embolism.
abstract: OBJECTIVE
  To clarify the cause of maternal deaths, an autopsy is essential. However, there has been no systemic analysis of maternal death in Japan based on autopsy cases.
  
  
  METHODS
  Maternal death reports were retrieved from a large amount of registered autopsy data on maternal death in the series of 'Annual of pathological autopsy cases in Japan'. These files contain 468,015 autopsy records from 1989 to 2004. We collected 193 cases of maternal death due to direct obstetric causes. We recorded all the data into Excel files. Then we analyzed the causes of death and classified them into 11 categories.
  
  
  RESULTS
  The causes of maternal death were as follows: amniotic fluid embolism (AFE), 24.3%; disseminated intravascular coagulation (DIC) related to pregnancy-induced hypertension, 21.2%; pulmonary thromboembolism, 13.0%; injury to the birth canal, 11.4%; medical and surgical complications, 9.8%; and atonic bleeding or DIC of unknown cause, 8.3%. A discrepancy between the clinical diagnosis and pathological diagnosis was frequently observed in cases of AFE, septic DIC and injury to the birth canal. AFE diagnosed by autopsy was often clinically diagnosed as atonic bleeding or DIC of unknown cause before death. Half of the cases of AFE diagnosed by autopsy were associated with DIC.
  
  
  CONCLUSIONS
  We found that AFE, DIC related to pregnancy-induced hypertension, pulmonary thromboembolism and injury to the birth canal were the major causes of maternal death in Japan. AFE had various clinical features such as uterine atony and DIC in addition to pulmonary cardiac collapse.
authors.affiliation: Departmqent of Obstetrics and Gynecology, Hamamatsu University School of Medicine, Handa-yama, Hamamatsu City, Japan. kanayama@hama-med.ac.jp
authors.forename: Naohiro
authors.initials: N
authors.lastname: Kanayama
authors.forename: Junko
authors.initials: J
authors.lastname: Inori
authors.forename: Hatsue
authors.initials: H
authors.lastname: Ishibashi-Ueda
authors.forename: Makoto
authors.initials: M
authors.lastname: Takeuchi
authors.forename: Masahiro
authors.initials: M
authors.lastname: Nakayama
authors.forename: Satoshi
authors.initials: S
authors.lastname: Kimura
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Matsuda
authors.forename: Jun
authors.initials: J
authors.lastname: Yoshimatsu
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Ikeda
mesh_terms: D004619:Embolism, Amniotic Fluid / Q000401:mortality*; D005260:Female; D006801:Humans; D007564:Japan; D008428:Maternal Mortality; D011247:Pregnancy; D011248:Pregnancy Complications / Q000401:mortality