Department of Diagnostic Pathology, Nara Hospital, Kindai University, Nara, Japan.
Department of Pathology, National Cerebral and Cardiovascular Center, Osaka, Japan.
Pathol Int. 2021 Apr;71(4):223-231. doi: 10.1111/pin.13076. Epub 2021 Feb 9.
The maternal mortality rate in Japan was 3.5 per 100 000 live births in 2017, similar to that reported in other developed countries. To reduce the number of maternal deaths, a Japanese nationwide registration and analysis system was implemented in 2010. Between January 2010 and April 2018, 367 maternal deaths were reported. Among them, by reviewing 80 autopsy records, the direct obstetric causes of death were identified in 52 women. The major causes of deaths were amniotic fluid embolism and acute pulmonary thromboembolism. The other 26 maternal deaths were associated with indirect obstetric causes including invasive Group A Streptococcus infection, aortic dissection, cerebral stroke and cardiomyopathies. This review highlights the importance of autopsy in maternal deaths. On analyzing 42 autopsy specimens obtained from registered cases of maternal death during 2012-2015, the 36% of causes of death by autopsy were discordant with the clinical diagnosis. Moreover, of the 38% of non-autopsied maternal death, the cause of death could not be clarified from the clinical chart. We emphasized that detailed autopsies are necessary to clarify the precise pathologic evidence related to pregnancy and delivery, especially causes of unexpected death such as amniotic fluid embolism.
2017 年，日本每十万例活产的孕产妇死亡率为 3.5，与其他发达国家报告的数据相似。为了降低孕产妇死亡人数，日本于 2010 年实施了全国性的登记和分析系统。2010 年 1 月至 2018 年 4 月，报告了 367 例孕产妇死亡。其中，通过回顾 80 份尸检记录，确定了 52 名妇女的直接产科死因。主要死亡原因是羊水栓塞和急性肺血栓栓塞。其他 26 例孕产妇死亡与间接产科原因有关，包括侵袭性 A 组链球菌感染、主动脉夹层、脑卒中和心肌病。本综述强调了尸检在孕产妇死亡中的重要性。在对 2012-2015 年期间登记的孕产妇死亡病例中获得的 42 份尸检标本进行分析后，尸检确定的死因与临床诊断不符的比例为 36%。此外，在 38%未经尸检的孕产妇死亡中，无法从临床图表中明确死因。我们强调，详细的尸检对于明确与妊娠和分娩相关的准确病理证据是必要的，尤其是羊水栓塞等意外死亡的原因。
