title: Analysis of maternal death autopsies from the nationwide registration system of maternal deaths in Japan.
abstract: OBJECTIVE
  To clarify the necessity for and problems related to autopsy for determining the cause of maternal death in Japan.
  
  
  METHODS
  Women who died during pregnancy or within a year after delivery were analyzed by the Maternal Death Exploratory Committee between 2012 and 2015 in Japan. Maternal deaths were analyzed to verify the requirement of autopsy in cases in which autopsy was performed and the need for autopsy in cases in which it was not performed.
  
  
  RESULTS
  Among the 49 cases performed autopsy, the final diagnosis was compatible with the clinical course in 24 cases, while the autopsy diagnosis was incompatible with the clinical course in 13 cases. In two cases, the final diagnosis was based on the clinical course, but an autopsy could exclude other possible causes. In three cases, no exact cause of maternal death was identified after autopsy. On the other hand, in cases without an autopsy, the final diagnosis was made using ante-mortem operating findings and surgical specimens in twenty-one cases. Though, thirty-one cases were estimated diagnosis based on post-mortem imaging or ante-mortem examinations, the exact original cause of death was not determined in 25 cases, and the cause of death could not be identified in eight cases without autopsy.
  
  
  CONCLUSIONS
  Because in most cases the autopsy provides an exact cause of death, the necessity of autopsies should be more widely accepted in Japan.
authors.affiliation: a Department of Obstetrics and Gynecology , St. Marianna University School of Medicine , Kanagawa , Japan.
authors.forename: Junichi
authors.initials: J
authors.lastname: Hasegawa
authors.affiliation: b Department of Diagnostic Pathology , Nara Hospital, Kindai University Faculty of Medicine , Ikoma , Japan.
authors.forename: Tomoko
authors.initials: T
authors.lastname: Wakasa
authors.affiliation: c Department of Legal Medicine , Osaka University Graduate School of Medicine , Osaka , Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Matsumoto
authors.affiliation: d Department of Pathology , Osaka Medical Center and Research Institute for Maternal and Child Health , Izumi , Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Takeuchi
authors.affiliation: e Department of Obstetrics and Gynecology , Hamamatsu University School of Medicine , Hamamatsu , Japan.
authors.forename: Naohiro
authors.initials: N
authors.lastname: Kanayama
authors.affiliation: f Department of Obstetrics and Gynecology , Mie University School of Medicine , Mie , Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Tanaka
authors.affiliation: g Department of Obstetrics and Gynecology , Sakakibara Heart Institute , Tokyo , Japan.
authors.forename: Shinji
authors.initials: S
authors.lastname: Katsuragi
authors.affiliation: h Department of Obstetrics and Gynecology , Toho University School of Medicine , Tokyo , Japan.
authors.forename: Masahiko
authors.initials: M
authors.lastname: Nakata
authors.affiliation: i Division of Perinatology , Maternal and Perinatal Care Center, Seirei Hamamatsu General Hospital , Hamamatsu , Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Murakoshi
authors.affiliation: f Department of Obstetrics and Gynecology , Mie University School of Medicine , Mie , Japan.
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Osato
authors.affiliation: j Department of Obstetrics and Gynecology , Showa University School of Medicine , Tokyo , Japan.
authors.forename: Masamitsu
authors.initials: M
authors.lastname: Nakamura
authors.affiliation: j Department of Obstetrics and Gynecology , Showa University School of Medicine , Tokyo , Japan.
authors.forename: Akihiko
authors.initials: A
authors.lastname: Sekizawa
authors.affiliation: k Ishiwata Obstetrics and Gynecology Hospital , Ibaraki , Japan.
authors.forename: Isamu
authors.initials: I
authors.lastname: Ishiwata
authors.affiliation: f Department of Obstetrics and Gynecology , Mie University School of Medicine , Mie , Japan.
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Ikeda
mesh_terms: D000328:Adult; D001344:Autopsy; D002423:Cause of Death; D005260:Female; D006801:Humans; D007564:Japan; D008428:Maternal Mortality; D008875:Middle Aged; D011247:Pregnancy; D055815:Young Adult
keywords: Autopsy; maternal mortality; obstetric hemorrhage; pregnancy