Keskin Hüseyin Levent, Engin Üstün Yaprak, Sanisoğlu Sema, Karaahmetoğlu Selma, Özcan Ayşe, Çelen Şevki, Tontuş Saniye, Üstün Yusuf, Ongun Veli, Şencan İrfan
General Directorate of Mother and Child Health and Family Planning, Ministry of Health of Turkey, Ankara, Turkey
J Turk Ger Gynecol Assoc. 2018 Nov 15;19(4):210-214. doi: 10.4274/jtgga.2018.0082. Epub 2018 Jun 8.
To analyze the value of autopsy reports for determining the cause of maternal deaths in Turkey.
In this descriptive retrospective study, the case files of 992 maternal deaths, except for accidental causes, that occurred in Turkey between 2012 and 2016 were reviewed. An autopsy examination was performed in 177 (17.8%) of the cohort. When the files were reviewed, maternal descriptive data and the cause of maternal mortality according to the autopsy reports were recorded.
The mean age at death was 31.5±6.6 years. No exact cause of maternal death was identified after autopsy in 44 (24.9%) of the 177 cases. An exact cause of death could be determined in 133 (75.1%); 34.5% (n=61) were due to direct causes, and 40.7% (n=72) were due to indirect causes. The leading direct causes of maternal deaths were obstetric hemorrhage (13.0%) and obstetric (pulmonary and amniotic fluid) embolism (12.4%). The main cause among the indirect causes was ruptured aortic aneurysm and/or dissection of aorta (8.5%). Among the subjects with no clinical diagnosis based on the clinical course before death (n=96), the exact cause of death could not be determined at autopsy in 19 (19.8%) cases. The exact or possible cause of death was identified at autopsy in 80.3% (n=77) cases with no clinical diagnosis. Among the cases who had antemortem diagnoses based on the clinical course (n=81), the final diagnosis at autopsy was compatible with the clinical diagnosis in 48 (59.3%) subjects.
Maternal autopsy examination provides an exact cause of death in most cases and is still a valuable tool for understanding the cause of maternal mortality.
分析尸检报告在确定土耳其孕产妇死亡原因方面的价值。
在这项描述性回顾性研究中，对2012年至2016年期间在土耳其发生的992例非意外原因导致的孕产妇死亡病例档案进行了审查。该队列中有177例（17.8%）进行了尸检。审查档案时，记录了孕产妇描述性数据以及根据尸检报告得出的孕产妇死亡原因。
死亡时的平均年龄为31.5±6.6岁。177例病例中有44例（24.9%）在尸检后未确定确切的孕产妇死亡原因。133例（75.1%）可确定确切的死亡原因；34.5%（n = 61）为直接原因，40.7%（n = 72）为间接原因。孕产妇死亡的主要直接原因是产科出血（13.0%）和产科（肺和羊水）栓塞（12.4%）。间接原因中的主要原因是主动脉瘤破裂和/或主动脉夹层（8.5%）。在生前死亡前临床过程无临床诊断的受试者中（n = 96），19例（19.8%）在尸检时无法确定确切的死亡原因。在生前无临床诊断的80.3%（n = 77）病例中，尸检确定了确切或可能的死亡原因。在生前根据临床过程有诊断的病例中（n = 81），48例（59.3%）受试者的尸检最终诊断与临床诊断相符。
孕产妇尸检在大多数情况下能提供确切的死亡原因，仍然是了解孕产妇死亡原因的重要工具。
