Yoneyama Koichi, Sekiguchi Atsuko, Matsushima Takashi, Kawase Rieko, Nakai Akihito, Asakura Hirobumi, Takeshita Toshiyuki
Department of Obstetrics and Gynecology, Nippon Medical School Musashi Kosugi Hospital.
J Nippon Med Sch. 2016;83(1):6-14. doi: 10.1272/jnms.83.6.
The aim of the present study was to elucidate the clinical characteristics of pregnancy-associated maternal deaths.
We performed a retrospective analysis with medical records and autopsy reports of cases of pregnancy-associated deaths. We collected information on all maternal deaths related to pregnancy that occurred in 3 hospitals affiliated with Nippon Medical School in Japan from January 1, 1984, to December 31, 2014. Data analyzed were maternal age, past medical history, parity, gestational age, clinical signs and symptoms, cause of death, and maternal autopsy findings.
A total of 26 maternal deaths occurred during the 31-year study period. Autopsies were performed for 16 patients (61.5%). The 26 deaths included 19 (73.1%) classified as direct maternal deaths and 7 (26.9%) classified as indirect maternal deaths. The mean maternal age at death was 33.1±4.3 years (range, 26-41 years). The highest percentage of women was aged 35 to 39 years (38.5%). Of the 26 maternal deaths, 69% occurred at 32 to 41 weeks of gestation. In cases of direct maternal death, the leading causes were amniotic fluid embolism (7 cases, 27.0% of all deaths) and hemorrhage (6 cases, 23.1% of all deaths). In cases of indirect obstetric deaths, the causes included cardiovascular disorders, cerebrovascular disorders, sepsis due to group A streptococcal infection, and hepatic failure of unknown etiology.
Amniotic fluid embolism was the leading cause of maternal deaths and was followed by obstetric hemorrhage. To prevent and reduce the number of maternal deaths in Japan, further basic and clinical research on amniotic fluid embolism is required.
本研究旨在阐明妊娠相关孕产妇死亡的临床特征。
我们对妊娠相关死亡病例的病历和尸检报告进行了回顾性分析。收集了1984年1月1日至2014年12月31日在日本日医大学附属的3家医院发生的所有与妊娠相关的孕产妇死亡信息。分析的数据包括产妇年龄、既往病史、产次、孕周、临床症状和体征、死亡原因以及产妇尸检结果。
在31年的研究期间共发生26例孕产妇死亡。16例患者（61.5%）进行了尸检。26例死亡中，19例（73.1%）被归类为直接孕产妇死亡，7例（26.9%）被归类为间接孕产妇死亡。死亡时产妇的平均年龄为33.1±4.3岁（范围26 - 41岁）。年龄最大的女性比例最高的是35至39岁（38.5%）。26例孕产妇死亡中，69%发生在妊娠32至41周。在直接孕产妇死亡病例中，主要原因是羊水栓塞（7例，占所有死亡的27.0%）和出血（6例，占所有死亡的23.1%）。在间接产科死亡病例中，原因包括心血管疾病、脑血管疾病、A组链球菌感染引起的败血症以及病因不明的肝衰竭。
羊水栓塞是孕产妇死亡的主要原因，其次是产科出血。为预防和减少日本孕产妇死亡人数，需要对羊水栓塞进行进一步的基础和临床研究。
