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ECPB 2014, 67(3): 64–67
Clinical physiology and biochemistry

Analysis of mortality causes associated with pregnancy and childbirth according to the data of lvivska oblast pathological department during a ten year period from 2000-2009

Pospishil Y. Holota O.
Abstract

Maternal mortality (MM) is defined by World Health Organization as a death of a woman during pregnancy or within forty-two days of termination of pregnancy irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes. Published data suggests that there are many MM causes and they vary based on geographic region. Most common etiologies are hemorrhage, sepsis and pre-eclampsia.

According to several studies extragenital pathology leading to MM comprises 12% to 50% with cardiomyopathy, infectious hepatitis, and pneumonia being most common etiologies. In aim to characterize MM causes in Lviv Region a study of causes of maternal mortality was conducted in Lviv Region during a ten year period (2000–2009) and data was compared with previous analogous ten year data (1985–1994). During 2000–2009, 8917 autopsies were performed in Lviv Region with 30 cases of MM. The age distribution among cases was following: 50% aged 20-29 years old, 47% aged 30–39 years old, 3% aged 18 years old. MM was observed most often during the first pregnancy (44%), followed by the second (17%) and the third (13%) pregnancy. In 93% of cases MM was related to preterm, term, or postterm labor. It was related to abortion in 7% of cases. In 53% of cases etiology of MM was related to pregnancy and labor: birth trauma in 5 cases (17%), hemorrhage in 4 cases (13%), sepsis in 3 cases (10%), with iatrogenic causes (complications related to C-sections), placental pathology, and amniotic fluid embolism rarely observed. In 47% of cases MM was secondary to extragenital pathology. The most common among these was cardiovascular pathology – total of 5 cases (two cases of endocarditis, one case of thrombophlebitis, one case of pulmonary hypertension, and one case of systemic vasculitis). Diseases of gastrointestinal and pulmonary systems were less common and included one case of acute pancreatitis and chronic liver abscess, and two cases of purulent pneumonia. Other causes included blood disorders (lymphgranulomatosis), trauma (blunt abdominal trauma), iatrogenic causes not related to pregnancy (complications related to central line placement in course of treatment of GI infection) with one case of each etiology. A comparison with previous data (1985–1994) yielded a decrease in MM by almost one-third, chiefly due to a significant decrease in pathology directly associated with pregnancy. Although the age distribution was similar (majority of MM cases occurred in ages less than 30 years old) the relative distribution of age groups has changed. In 1985–1994, 69% of MM cases occurred in women younger than 30 years old and 31% of cases occurred in women older than 30 compared to 53% and 47% in 2000–2009, respectively. In Lviv Region during the time period from 2000 –2009 the major causes of MM due to pathology related directly to pregnancy were birth trauma, bleeding, and sepsis while in 1985–1994 pre-eclampsia was the most common etiology of MM. Although the quantity of extragenital pathology remained almost the same, its type has changed.

Among extragenital pathology, the most common cause of MM during 2000–2009 was cardiovascular disease as compared to gastrointestinal disease during 1985–1994.

Keywords: maternal mortality, pregnancy, extragenital pathology

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