IN THE NAME OF GOD

A comparison of maternal autopsy & clinical

diagnosis in Kermanshah , Iran 2007-2011

Fakheri TaravatAssociate prof

KUMS

Autopsy

• Post-mortem examination . • Highly specialized surgical exam.• To determine the cause and manner of death.• To evaluate any disease or injury.

• "gold standard" for cause of death .

Autopsy

• Forensic autopsy , cause of death criminal. • Clinical or academic autopsy, find medical

cause of unknown or uncertain death, or research purposes.

Autopsy• 1=External examination • 2=Body is dissected and internal examination

is conducted. • Permission from next of kin may be required

for internal autopsy in some cases.• When internal autopsy is complete the body is

reconstituted by sewing it back together

Verbal autopsy• As part of a demographic surveillance system by research institutions to collect records of births and deaths periodically among small populations (typically in a district).

Verbal autopsy

• Cause of death through interviews with family or community members

• Medical certification of cause of death is not available.

Verbal autopsy

• Misclassification of causes of deaths.

• Fail to identify , esp (EP, abortion-related) and indirect causes .

• Requires physician assessment and long interviews.

• Findings cannot be extrapolated to obtain national MMRs.

Accuracy

• 1=extent of family members’ knowledge of the events leading to the death,

• 2=the skill of the interviewers,• 3=Competence of physicians who do the

diagnosis and coding. • The latter two factors are largely overcome by

the use of software.

Method &Material

• Descriptive, • Retrospective review • Postmortem autopsy • Cases of maternal committee death records • Kermanshah University of Medicine• 5-year period.

• All maternal mortality committee records • year 2007-2012• Investigated and compared with the records of

forensic medicine center records of autopsied patients.

• Check list filled and assayed with the spss19.

Findings

• 43 cases of autopsied maternal death registered.

Frequency according to year

yr1386 yr1387 yr1388 yr1389 yr13900

2

4

6

8

10

12

14

Series1

Frequency according to age

<20 yr 21-30 yr 31-40 yr 41-50 yr0

5

10

15

20

25

Series1

Frequency according to age

• The average age of maternal death was 31.3±3.6 .

Frequency according to place

hospital home road0

5

10

15

20

25

30

35

40

Chart Title

Series1

Frequency according to residence

• 32 (74%) =Urban

• 11(26%) =Rural

Frequency according to residence

Urban74%

Rural26%

Chart Title

Maternal mortality etiology

DirectIndirectPreg related

Direct maternal mortality

PE DIC HELLP AFE PPH SS TTP CHOAMN0

1

2

3

4

5

6

Series1

Autopsy finding Direct MM

PULMO EDEMA PORT HEP INF MYOMETER HEM PULM INF PULM HEM0

1

2

3

4

5

6

7

8

9

10

Series1

Indirect maternal mortality

ARFppht

CMPSO

L

CARDIA

PNEUMONA

ASTHMA MS

ICHAPS

EISEN

-MG

ACUTE PANC

0

0.5

1

1.5

2

2.5

3

Series1

Autopsy finding Indirect MM

PULMOED PORT HEP PULMO INF PULMO ANTRA PULMO HEM0

2

4

6

8

10

12

14

Series1

The comparison of maternal autopsy & clinical diagnosis

• In 39/43 or(90.6%) of cases there was concordance of clinical & autopsy finding & in only 4/43 or (9.4%) the diagnosis was different.

Clinical diagnosis Autopsy finding

PULMONARY EMBOLI SEPSIS

ECLAMPSIA IATROGENIC HEMORRHAGE

DIC HEMORRHAGE DUE TO ABORTION

PNEUMONIA PULMONARY FIBROSIS

Discussion

Discordance

• In our study the rate was 9.4% which is in accordance with the lowest reported rate.

• 75% of discordance due to direct causes.

Discordance

• Mexico ; 100% concordance in D cases, a 60% discordance in I cases.

• Africa ; 34 of the 84 cases (38.1%).

• false - ; infectious diseases, sensi< 50%:

• false + ; Eclampsia, PPV =42.9%.

• Japan ; AFE, septic DIC &birth canal injury • Africa ; in 56 (40.3%) maternal deaths.

Substantial discordance

• 10% to more than 30% • To 40% of physician-certified deaths will be

present in verbal autopsy data.

Conclusion

• What is now needed ?• In low- and middle-resource countries , robust

studies of the concordance of verbal and diagnostic pathology autopsy to assess the contribution that diagnostic pathology autopsy can make to the quality of verbal autopsy and other mortality data.

Conclusion

• Continuous evaluation of deaths by diagnostic pathology autopsy in conjunction with verbal autopsy

• Promote continuous quality assessment• Improvement of mortality data, • Facilitate the identification of new or

emerging disease processes.

WITH THANKS