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

Maternal mortality, a global concern, is mitigated by the accurate determination of the cause of death. Maternal death autopsies in our institution fall under pathology, except those under forensic medicine due to medicolegal implications. This study compares provisional (PCOD) and final (FCOD) causes of death in maternal autopsies, driven by queries from clinicians during Maternal Death Review meetings regarding discrepancies between the two. This retrospective study analyzed 92 maternal death autopsies with discrepancies between PCOD and FCOD, over a 6-year period at a tertiary care hospital. Discrepancies were classified into major and minor for organ-specific diagnoses. The commonest encountered pathologies were assessed for true positives, false positives, and false negatives. Major and minor discrepancies were categorized for direct and indirect causes of maternal death. Analysis of 137 diagnoses in these 92 maternal deaths showed the lung was the most common site of discrepancy (78% were major), followed by the brain, liver, kidney, and heart. Acute respiratory distress syndrome (ARDS) and bronchopneumonia caused significant maternal death; 75% of ARDS cases had major discrepancies, mostly due to misdiagnosis as intrapulmonary hemorrhage or bronchopneumonia on gross examination. Discrepancies between gross and histopathologic findings reflect unavoidable diagnostic challenges due to inherent limitations of gross pathology, particularly with overlapping appearances.