Provisional Versus Final Cause of Maternal Death on Autopsy: Exploring the Gaps

Area of Science:

• Pathology
• Forensic Medicine
• Obstetrics & Gynecology

Background:

• Accurate determination of maternal mortality cause is vital globally.
• Maternal death autopsies are typically pathology-based, excluding medicolegal cases.
• Clinical queries prompted this investigation into autopsy diagnosis discrepancies.

Purpose of the Study:

• To compare provisional (PCOD) and final (FCOD) causes of death in maternal autopsies.
• To analyze discrepancies and their impact on understanding maternal mortality.
• To identify common pathologies and organs involved in diagnostic discrepancies.

Main Methods:

• Retrospective analysis of 92 maternal death autopsies with PCOD/FCOD discrepancies over 6 years.
• Classification of discrepancies into major and minor categories.
• Assessment of common pathologies for diagnostic accuracy (true/false positives/negatives).

Main Results:

• The lung was the most frequent site of discrepancy (78% major), followed by brain, liver, kidney, and heart.
• Acute respiratory distress syndrome (ARDS) and bronchopneumonia were common causes of death with high discrepancy rates (75% major for ARDS).
• Misdiagnosis on gross examination, particularly for ARDS, contributed to discrepancies.

Conclusions:

• Significant discrepancies exist between provisional and final autopsy diagnoses in maternal deaths.
• Gross pathological limitations, especially with overlapping features, contribute to diagnostic challenges.
• Improving autopsy accuracy is essential for precise maternal mortality attribution and review.