The Pathology of Maternal Mortality

1.0 Introduction 1.1 Scope 1.2 Historical overview 1.3 Sample selection 1.4 Study methods

2.0 Working definition of maternal mortality 2.1 Definition developed from this study 2.2 The American College working definition

3.0 Perinatal mortality within maternal mortality 3.1 Net sample size 3.2 Perinatal mortality

4.0 Classification of maternal mortality 4.1 Arrangement of the classification 4.2 Group one: Conditions unique to pregnancy

4.2.1 Amniotic fluid embolism/ dissemi-nated intravascular coagulation (AFE / DIC)

4.2 .2 Ectopic pregnancy 4.2.3 Gestosis 4.2.4 Hemorrhage, nongestotic, extra-

cranial 4.2.5 Neoplasms, obstetric 4.2 .6 Therapeutic misadventure

4.3 Group two: Pregnancy probable major con-tributory factor 4.3.1 Air embolism 4.3.2 Anesthetic misadventure 4.3.3 Cardiovascular factors -congenital

heart disease 4.3.4 Pulmonary thromboembolism 4.3.5 Renal fai lure 4.3.6 Sepsis / infection

4.4 Group three: Intercurrent disease or preg-nancy an uncertain or minor factor 4.4.1 Accidental 4.4.2 Cardiovascular factors-acquired

heart disease 4.4.3 Complex pathogenesis 4.4.4 Intracranial vascular incidence, non-

gestotic 4.4 .5 Neoplasm - nonobstetric 4.4.6 Sepsis / infection 4.4.7 Sicklemic / thalassemic manifestations 4.4.8 Status asthmaticus

1126

4.4.9 Thrombotic thrombocytopenic purpura

4.4.10 Thyrotoxicosis 4.4.11 Toxic pancytopenia 1.·1.12 {Tncb"ifH'd

5.0 Mortal conditions unique to human gestation 5.1 General

6.0

7.0

8.0 9.0

5.2 Amniotic fluid embolism

5.3 Ectopic pregnancy 5.4 Gestosis ("toxemia of pregnancy")

5.4. 1 Age range 5.4.2 Gravidity-parity 5.4.3 Gestational age 5.4.4 Perinatal mortality 5.4.5 Pathologic findings

5.5 Extracranial nongestotic hemorrhage 5.6 Obstetric neoplasms 5.7 Therapeutic misadventure Pregnancy: A probable major contributory factor 6.1 General 6.2 Air embolism, post coital 6.3 Anesthetic misadventure 6.4 Congenital cardiovascular disease 6.5 Pulmonary thromboembolism 6.6 Renal failure 6.7 Obstetric infection with sepsis Intercurrent disease or pregnancy an uncertain or minor factor 7.1 General 7.2 Accidental death 7.3 Acquired or nonanomalous heart disease 7.4 Complex pathogenesis 7.5 Nongestotic intracranial vascular incident 7.6 Nonobstetric neoplasms 7.7 Infection or sepsis 7.8 Sicklemic-thalassemic manifestations 7.9 Status asthmaticus 7.10 Thrombotic thrombocytopenic purpura 7.11 Thyrotoxicosis 7.12 Toxic pancytopenia 7 .13 Unclassified Pathologic investigation of maternal deaths References