Maternal Mortality. Lessons Learnt from Autopsy

Part: I - Direct Maternal Death.- Catastrophic Abruptio Placentae- An Autopsy Case Series.- Liver Infarct in Pregnancy: A Complex, Rare and Dreadful Affair.- Cerebral Venous Sinus Thrombosis – An Avertable Catastrophe.- Fatty Liver: More Likely to be Fatal in Pregnancy!.- Eclampsia: A Risk Factor for Intracranial Haemorrhage.- Cervical Trauma: Clinical Conundrum and Correlation.- Amniotic Fluid Embolism Syndrome: A Rare, Unpredictable and Catastrophic Complication of Pregnancy.- Systemic Thromboembolism and Giant Gastric Mucor Ulcer.- Puerperal Sepsis: A Preventable Cause of Maternal Death.- Peri-partum Cardiomyopathy- Failed Cardiac Physiology.- HELLP Syndrome: The Snowball Effect.- Uterine Anomalies: Less Common but Lethal if not Detected.- Retained Products of Conception and Dilatation & Curettage: A cause for Disseminated Intravascular Coagulation.- Part: II - Indirect Maternal Death.- Pulmonary Bone Marrow Embolism: The Uncommon but Fatal Complication of Sickle Cell Disease.- Neurocysticercosis, Pregnancy and Albendazole – The Unholy Trio.- Lupus Nephritis and Pregnancy: Concern for Both Mother and Fetus.- Disseminated Microthrombi in Pregnancy: Not Always DIC, Think of TTP.- Hepatitis E Virus Associated Hepatic Necrosis.- H1N1 Influenza in Pregnancy – Yet Another Dreaded Flu.- “Über Diffuse” Myocarditis: Still a Giant Mystery!.- Liver: A Fatal Target of Sepsis Related Organ Dysfunction.- Complicated Malaria in Pregnancy.- Adrenal Hemorrhage: A Dark Horse in Maternal Mortality.- Disseminated Miliary Tuberculosis: A classic Case of Fatality!.- Disseminated Miliary TB with Missing Millet Tubercles on Gross: Suspect Severe Immunocompromised State.- Mystic Hepatopathy in a Sickle Hemoglobinopathy.- Acute Hemorrhagic Pancreatitis and Sepsis: A Cause for Maternal Death.- Maternal Death due to Nonhodgkins Lymphoma.- Normal Physiologic Changes of Gravid Uterus.- Lobar Pneumonia: A Fatal Non-Obstetric Infection!.- Uterine Arterio-Venous Malformation.- Herpes Simplex Pneumonitis.- Renal Cortical Necrosis in Pregnancy: Still a Sad Reality in Developing Countries.- Severe Anaemia and Pregnancy.- Hypertrophic Cardiomyopathy as an Incidental Finding.- Gastro-Intestinal Candidiasis – An Unusual Accompaniment.- Plugging of Visceral Blood Vessels by Atypical Cells: Clue to Leukemia!.- Chronic Kidney Disease Masquerading as Pregnancy Induced Hypertension.- Pulmonary Edema and Aspiration Pneumonia- Cause for Maternal Death.- Post-Partum Febrile Illness - Recurrent Acute Rheumatic Fever.- Common Atrio-Ventricular Canal: A Fatality Due to A Commonality.- Choked Prosthetic Mitral Valve.- Interstitial Lung Disease: Scarred, Stiff Lungs with Honeycombing.- Diffuse Alveolar Damage in Covid 19 infection.- Takayasu Arteritis – Third Trimester Tragedy.

The book discusses about 45 cases of maternal autopsies. These maternal mortalities are related to pregnancy-related diseases, pre-existing diseases that worsen or manifest during pregnancy and diseases for which pregnant patient has increased risk. As the study of maternal mortality is a healthcare quality indicator and plays an important role in the improvement of obstetric care, the book aims at discussing autopsy findings, which is the gold standard for establishing not only the causes of death, but also to uncover the various pathological lesions produced by the physiologic phenomenon of pregnancy. This helps in identifying the direct and indirect causes, which can be reviewed at multidisciplinary review meetings.

The chapters are arranged according to direct and indirect causes of maternal death, involving varied target organ systems i.e. central nervous system, cardiovascular system, respiratory system, gastro-intestinal tract, hepato-biliary system and pancreas, urinary system, female genital tract and others. However, it does not include diseases coincidental in pregnancy.

Each case begins with the complete case history (age, duration of pregnancy, clinical presentation, investigations, clinical diagnosis, therapy, and course during ward stay, if any), autopsy findings, followed by a clinico-pathological discussion and includes appropriate gross organ and microscopic images.

The book caters to the specialists in pathology, obstetrics, general medicine, critical care, surgery, pulmonologists, cardiology and all those involved in the care of pregnant women.

Dr. Kusum Jashnani is currently the Professor and Head of Department of Pathology, Topiwala National Medical College, Mumbai, India. She has done her post-graduation, MD pathology from Seth GS Medical College and KEM Hospital, Mumbai. She has a special interest in cytopathology, gynecologic pathology, placental pathology and maternal autopsy and has participated as a faculty in various conferences and CMEs. Dr. Jashnani was the Organizing Secretary for CMEs on gynecologic pathology and cytopathology. She has several publications in various national and international journals and has been a postgraduate guide for MD pathology students.