Junichi Hasegawa1, Tomoko Wakasa2, Hiroshi Matsumoto3, Makoto Takeuchi4, Naohiro Kanayama5, Hiroaki Tanaka6, Shinji Katsuragi7, Masahiko Nakata8, Takeshi Murakoshi9, Kazuhiro Osato6, Masamitsu Nakamura10, Akihiko Sekizawa10, Isamu Ishiwata11, Tomoaki Ikeda6. 1. a Department of Obstetrics and Gynecology , St. Marianna University School of Medicine , Kanagawa , Japan. 2. b Department of Diagnostic Pathology , Nara Hospital, Kindai University Faculty of Medicine , Ikoma , Japan. 3. c Department of Legal Medicine , Osaka University Graduate School of Medicine , Osaka , Japan. 4. d Department of Pathology , Osaka Medical Center and Research Institute for Maternal and Child Health , Izumi , Japan. 5. e Department of Obstetrics and Gynecology , Hamamatsu University School of Medicine , Hamamatsu , Japan. 6. f Department of Obstetrics and Gynecology , Mie University School of Medicine , Mie , Japan. 7. g Department of Obstetrics and Gynecology , Sakakibara Heart Institute , Tokyo , Japan. 8. h Department of Obstetrics and Gynecology , Toho University School of Medicine , Tokyo , Japan. 9. i Division of Perinatology , Maternal and Perinatal Care Center, Seirei Hamamatsu General Hospital , Hamamatsu , Japan. 10. j Department of Obstetrics and Gynecology , Showa University School of Medicine , Tokyo , Japan. 11. k Ishiwata Obstetrics and Gynecology Hospital , Ibaraki , Japan.
Abstract
OBJECTIVE: To clarify the necessity for and problems related to autopsy for determining the cause of maternal death in Japan. METHODS: Women who died during pregnancy or within a year after delivery were analyzed by the Maternal Death Exploratory Committee between 2012 and 2015 in Japan. Maternal deaths were analyzed to verify the requirement of autopsy in cases in which autopsy was performed and the need for autopsy in cases in which it was not performed. RESULTS: Among the 49 cases performed autopsy, the final diagnosis was compatible with the clinical course in 24 cases, while the autopsy diagnosis was incompatible with the clinical course in 13 cases. In two cases, the final diagnosis was based on the clinical course, but an autopsy could exclude other possible causes. In three cases, no exact cause of maternal death was identified after autopsy. On the other hand, in cases without an autopsy, the final diagnosis was made using ante-mortem operating findings and surgical specimens in twenty-one cases. Though, thirty-one cases were estimated diagnosis based on post-mortem imaging or ante-mortem examinations, the exact original cause of death was not determined in 25 cases, and the cause of death could not be identified in eight cases without autopsy. CONCLUSION: Because in most cases the autopsy provides an exact cause of death, the necessity of autopsies should be more widely accepted in Japan.
OBJECTIVE: To clarify the necessity for and problems related to autopsy for determining the cause of maternal death in Japan. METHODS:Women who died during pregnancy or within a year after delivery were analyzed by the Maternal Death Exploratory Committee between 2012 and 2015 in Japan. Maternal deaths were analyzed to verify the requirement of autopsy in cases in which autopsy was performed and the need for autopsy in cases in which it was not performed. RESULTS: Among the 49 cases performed autopsy, the final diagnosis was compatible with the clinical course in 24 cases, while the autopsy diagnosis was incompatible with the clinical course in 13 cases. In two cases, the final diagnosis was based on the clinical course, but an autopsy could exclude other possible causes. In three cases, no exact cause of maternal death was identified after autopsy. On the other hand, in cases without an autopsy, the final diagnosis was made using ante-mortem operating findings and surgical specimens in twenty-one cases. Though, thirty-one cases were estimated diagnosis based on post-mortem imaging or ante-mortem examinations, the exact original cause of death was not determined in 25 cases, and the cause of death could not be identified in eight cases without autopsy. CONCLUSION: Because in most cases the autopsy provides an exact cause of death, the necessity of autopsies should be more widely accepted in Japan.