Autopsy and Medicolegal Evaluation in a Case of Sudden Maternal Death from Pulmonary Embolism

Pulmonary embolism in pregnancy is a significant and under-recognized problem. In British Columbia, where there are 46,000 pregnancies per year, it is estimated that there are approximately 160 pulmonary embolisms per year and one maternal death every two years secondary to pulmonary embolism. A complete assessment for suspected pulmonary embolus can be performed without putting the fetus at significant risk from radiation exposure. An algorithm is provided for the workup of pulmonary embolus during pregnancy. Heparin is the drug of choice for anticoagulating pregnant women, initially managing the situation with intravenous heparin and then switching to the subcutaneous route given in a bid or tid regimen, aiming to keep the activated partial thromboplastin time 1.5 to 2 times the control. The risks to both the fetus and the mother from anticoagulation during pregnancy are reviewed.

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Comparison of Causes of Maternal Mortality in the Limpopo Province between 2011/13 and 2014/16: Findings from the National Committee of Confidential Enquiry into Maternal Deaths in South Africa

10.21203/rs.2.13378/v1 ◽

2019 ◽

Author(s):

Sam Ntuli ◽

Maboya EM ◽

FLM Hyera ◽

S Naidoo

Keyword(s):

South Africa ◽

Pulmonary Embolism ◽

Maternal Death ◽

Statistical Significance ◽

Limpopo Province ◽

National Committee ◽

Confidential Enquiry ◽

Maternal Deaths ◽

Hypertensive Disorders ◽

Obstetric Haemorrhage

Abstract Objective To review and compare underlying causes of maternal deaths in Limpopo Province (LP) using data of the National Committee of Confidential Enquiry into Maternal Deaths in South Africa (NCCEMD). Method This is a review of the findings of the causes of maternal deaths from the two trienniums 2011-2013 and 2014-2016 of the NCCEMD. When pregnancy related deaths occur a maternal death notification form is completed and submitted to the provincial Maternal, Child and Women's Health (MCWH) units. The provincial assessors assess the death and forward the report to the NCCEMD, where the data are collated and analyzed to provide summary estimates for the extent of important public-health problems. Results In the triennial 2011/13, 750 women deaths were recorded in LP of which 728 (97.1%) were maternal deaths and 22(2.9%) were coincidental deaths. While in the triennial 2014/16, of the 623 women deaths, 607(97.4%) were maternal deaths and 16 (2.6%) were coincidental deaths. In both trienniums, non-pregnancy related infections, obstetric haemorrhage, pregnancy-induced hypertensive disorders and medical and surgical disorders were the leading cause of deaths and accounted for two-thirds of maternal deaths. The number of deaths due to non-pregnancy related infections significantly decreases from 228 to 135 (p<0.05), while deaths due to medical and surgical disorders slightly increased (from 66 to 69, p>0.05). There was a marked reduction in the number of obstetric haemorrhage, pregnancy-induced hypertensive disorders, pregnancy-related sepsis, anaesthetic complications, ruptured ectopic pregnancy and acute collapse-cause unknown but the result did not reach statistical significance (p>0.05), and deaths due to miscarriage increased (p>0.05). The number of deaths due to pulmonary embolism increased significantly (p<0.05). Conclusion Although there is a reduction in the number of maternal deaths in LP, non-pregnancy related infections, obstetric haemorrhage, pregnancy-induced hypertensive disorders and medical and surgical disorders remain the major causes of maternal death and pulmonary embolism is an emerging concern.

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