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Abstract
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Summary
The death of a pregnant woman is dramatic for her family as for the medical staff and the entire society. How can this mortality be reduced? In order to determine the epidemiology and causes of maternal mortality in a French population, we carried out a retrospective study of all obstetrical deaths autopsied in a French forensic pathology department between 1987 and 2009. We studied all the cases in which a woman was pregnant or had delivered in the 42 days prior to death, whichever the manner of death was. During this 22-year period, 36 obstetrical deaths were autopsied out of 7,705 autopsies in total (0.47% of cases). The average age at death was 29.5 (17 to 39 years old). The majority of deaths (69.4%) was of natural origin (n = 25), 16.7% were homicides (n = 6), 8.3% were suicides (n = 3), and 5.6% were accidental (n = 2). Most of deaths (30.6%) occurred during delivery (n = 11), with an equivalent repartition during the three quarters (19.4% per period, i.e. n = 7) and 11.1% during post-partum time (n = 4). Causes of natural deaths were amniotic emboli (n = 5) followed by cerebral or aortic arterial rupture (n = 4), uterine rupture (n = 3), delivery hemorrhage (n = 3), infection (n = 3), cardiomyopathy (n = 3), extra-uterine pregnancy accident (n = 2), pulmonary embolism (n = 2) and anesthesia complication (n = 1). These results gave us the opportunity to suggest original prevention and screening acts that may be of interest for the public health policy and forensic physician practices. First, we insist on the search for preliminary pathology and risk factors: tobacco (nicotinic intoxication), alcoholism, drug-addiction and psychological weakness. Second, a systematic electrocardiogram (ECG) at the beginning of pregnancy would help in the detection of an existing cardiomyopathy, while keeping in mind that it is not sufficient to eliminate any cardiac risk. Lastly, any symptom usually considered as ordinary may correspond to a serious complication of pregnancy. |