Evaluation of Demographic, Clinical and Autopsy Data of Autopsied Maternal Deaths in Turkey

Abstract

Aim: Maternal mortality is an important public health issue. In this study, it is aimed to evaluate pregnancy related maternal deaths in a multi-dimensional manner, focusing on not only demographic and clinical characteristics but also autopsy results by including the maternal death cases having autopsy reports. Material and Method: There were 1037 pregnancy related deaths in Turkey, between 2010 and 2014, and 17.3 % (n=180) of them had an autopsy report. Autopsied maternal deaths were evaluated in this sutdy. Data of autopsied pregnancy related deaths were obtained from the nationwide registration system of Woman and Reproductive Health Department of Turkish Ministry of Health and Turkish Ministry of Justice-Council of Forensic Medicine and evaluated retrospectively. Characteristics and cause of maternal deaths autopsied between 2010 and 2014 were evaluated. Age, cause of death, pregnancy state at the time of death, place of birth, mode of delivery, time of death, pregnancy outcomes, place of death, and delay-model were evaluated. Results: In this study, 61.1% (n=110) of all pregnancy related deaths were ≥30 years of age. Direct maternal deaths were 35% (n=63) of the cases, such as hemorrhage 14.5% (n=26), embolus 6.7% (n=12), uterine rupture 5% (n=9), preeclampsia/eclampsia 4.4% (n=8) and others 4.4% (n=8). Indirect maternal deaths were 56.1% (n=101) of the cases, such as cardiovascular disease 37.2% (n=67), infection 7.8% (n=14), cerebrovascular disease 6.7% (n=12), and others 4.4% (n=8). In 8.9% (n=16) of the cases, the cause of death was not determined. Deaths occurred in the postpartum period in 61.1% (n=110) of the cases. Deaths occurred in a healthcare facility in 71.1% (n=128) of the cases. One or more delays were determined in 33.9% (n=61) of the cases. Conclusion: According to the results of the present study, cardiovascular disease related to maternal mortality has been found to be an increasing, important public health concern to consider for maternal health routines. In addition, as a second outcome of this study, we can emphasize that, although, the exact cause of death could not be determined even after autopsy in 16 cases (8.9%), autopsy is still one of the most valuable assessment tools to highlight important possible clinical and administrative improvements to reduce maternal mortality.

Keywords

• maternal mortality
• autopsy
• cardiovascular disease
• maternal mortalite
• otopsi
• kardiyovasküler hastalık