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Journal Article
Maternal Mortality: An Autopsy Audit
2009
Overview
Background: The process of audit standardizes protocols in departments
and has long-term benefits. Maternal autopsies though routinely
performed, deserve a special attention. Aims: 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. Materials and 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. Conclusion: 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.
Publisher
Medknow Publications and Staff Society of Seth GS Medical College and KEM Hospital, Mumbai, India,Medknow Publications and Media Pvt. Ltd,Medknow Publications & Media Pvt. Ltd
