An autopsy study of 306 cases of maternal death in Japan.

Based on autopsy findings in 306 cases of maternal death from 1964 to 1980, recent trends in maternal death in Japan were discussed. Main topics dealt with were as follows: 1. Although rate of maternal death in Japan is decreasing markedly year by year, approximately 90 per cent of our autopsy cases were direct or indirect maternal deaths. 2. The most common category of the direct maternal death was hemorrhage. Unexpectedly uterine rupture was thought to be a common etiological factor for that. 3. One of the most valuable impression obtained in this study was a high percentage of "sudden death". In our series, 85 of 306 cases (27.8 per cent) were of maternal deaths within 6 hours after their general condition began to deteriorate. The first cause of sudden death was hemorrhage, and the second and the third were ectopic pregnancy and amniotic fluid embolism respectively. 4. Although it was very difficult, 16 cases (5.2 per cent) were judged as the maternal death possibly related to drugs. The most widely suspected and used drugs were hysterotonica such as prostaglandin, oxytocin and Deliverin. In these 16 cases of maternal deaths possibly related to drugs either directly or indirectly, amniotic fluid embolism (in 6 cases), uterine rupture (in 3 cases), and cervical laceration (in 2 cases) were confirmed at autopsy and diagnosed as the direct cause of death. However, in the remaining 5 cases, no acceptable findings could be obtained and an exact cause of death had remained unsolved. 5. Fifteen cases (4.9 per cent) of amniotic fluid embolism were confirmed by autopsy. However, only in 6 out of 15 cases, a clinical diagnosis of amniotic fluid embolism was given. In the remaining 9 cases, clinical diagnoses such as "shock of unknown etiology", "septic or endotoxin shock" and "postpartum collapse" were presumed.