Maternal Mortality - Lessons Learnt from Autopsy

227 Pages·2022·30.027 MB·English

by  Kusum D. Jashnani

Maternal Mortality -
Lessons Learnt
from Autopsy
Kusum D. Jashnani
Editor
123
Maternal Mortality - Lessons Learnt
from Autopsy
Kusum D. Jashnani
Editor
Maternal Mortality -
Lessons Learnt
from Autopsy
Editor
Kusum D. Jashnani
Department of Pathology
Topiwala National Medical College & B.Y.L. Nair Charitable Hospital
Mumbai, Maharashtra, India
ISBN 978-981-19-3419-3 ISBN 978-981-19-3420-9 (eBook)
https://doi.org/10.1007/978-981-19-3420-9
© The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature
Singapore Pte Ltd. 2022
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To my Father Mr. Harkishindas Chhabaldas Nainaney
This compilation of case reports of the deceased patients’
autopsies does not contain any identifiable information about
any patient. The confidentiality and autonomy of each deceased
patient is maintained throughout the manuscript and also in the
images (both gross and microscopy) provided. All details that
would enable any reader (including the individual or anyone
else) to identify the deceased person are omitted. Principal
author and all co-authors take full responsibility for this. This
publication’s benefits towards the society outweigh any potential
harm.
Preface
Maternal mortality is an important public health problem with socioeconomic
and clinical implications. Female death from any cause related to or aggra-
vated by pregnancy or its management (excluding accidental or incidental
causes) during pregnancy or within 42 days of childbirth or of an abortion,
irrespective of the duration and site of the pregnancy, is defined as maternal
mortality/death.
Direct maternal deaths are those “resulting from obstetric complications
of the pregnant state (pregnancy, labour and puerperium), and from interven-
tions, omissions, or incorrect treatment.” Conditions like abruptio placentae,
uterine rupture, and pulmonary thromboembolism are direct causes of mater-
nal death. Indirect maternal deaths are those maternal deaths “resulting from
previous existing disease or disease that developed during pregnancy and not
due to direct obstetric causes but were aggravated by the physiologic effects
of pregnancy.” These include causes like chronic rheumatic heart disease,
massive hepatic necrosis in HEV infection, severe anemia, and other infec-
tions like tuberculosis. Severe obstetric hemorrhage, puerperal sepsis, hyper-
tensive disorders of pregnancy, and unsafe abortion constitute common
causes of direct maternal deaths in developing countries. Accurate determina-
tion of causes of maternal deaths is critical for effective prevention, for which
the gold standard evaluation for maternal deaths is autopsy or postmortem.
Maternal Death Review (MDR) process was started by the Government of
India in the year 2010, to improve the quality of obstetric care & reduce
maternal mortality by identifying gaps in existing health care. In our Institute
of BYL Nair Ch. Hospital and TNMC, Mumbai, such meetings were already
in place, being conducted by Dr Asha R Dalal, then HOD of Obstetrics &
Gynecology Department, from the year 2003. It used to be a multidisciplinary
meeting, with active participation of all concerned doctors, including presen-
tation of autopsy findings by me. Maternal mortality ratio (MMR) in our
Institute as well as in Mumbai city has shown a slight increase in trend over
the years. The reason being late referrals of complicated cases from periph-
eral hospitals, nursing homes and hospitals from districts outside Mumbai.
https://www.ncbi.nlm.nih.gov/p. More collaborative efforts are needed to
bring down the MMR.
There are occasional cases, where even after complete gross and histo-
pathologic examination after autopsy, I do not find a cause of death. I discuss
these cases with the treating intensivists/obstetricians, and a consensus cause
of death is then given. In this book, different cases of maternal death on
ix
x Preface
autopsy—direct as well as indirect—are discussed with complete clinico-
pathologic correlation, showing corresponding gross morphology and histo-
pathology pictures. I am sure each of these cases will serve as a learning
material to pathologists, obstetricians, intensivists, physicians, and all those
involved in maternal care, and hospital administrators. What a better way to
learn than getting to see authentic pictures of organs, pertaining to each case
with complete clinicopathologic correlation. It has been rightly said that
“Much can be learned about the living from the study of dead”—Autopsy and
Audit (RC Path, RCP, RCS, 1991).
Thank You
Mumbai, Maharashtra, India Kusum D. Jashnani
Contents
Part I Direct Maternal Deaths
1 Catastrophic Abruptio Placentae: An Autopsy
Case Series . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Kusum D. Jashnani, Sumit Kumar Mandal, Lalita Yoganand
Patil, and Vandana Rajesh Saravade
2 Liver Infarct in Pregnancy: A Complex,
Rare and Dreadful Affair . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Kanchan Dilip Trichal, Kusum D. Jashnani,
and Vrinda Kiran Kulkarni
3 Cerebral Venous Sinus Thrombosis: An
Avertable Catastrophe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Asha Shenoy
4 Fatty Liver: More Likely To Be Fatal in Pregnancy! . . . . . . . . . . 17
Kusum D. Jashnani, Lalita Yoganand Patil, Shruti Lande,
and Rosemarie de Souza
5 Eclampsia: A Risk Factor for
Intracranial Hemorrhage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
Sakshi Agrawal, Kusum D. Jashnani, Lalita Yoganand Patil,
and Vandana Rajesh Saravade
6 Cervical Trauma: Clinical Conundrum and Correlation . . . . . . 25
Kusum D. Jashnani and Reena J. Wani
7 Amniotic Fluid Embolism Syndrome: A Rare,
Unpredictable, and Catastrophic Complication
of Pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
Kusum D. Jashnani, Sakshi Agrawal, and Asha R. Dalal
8 Systemic Thromboembolism and Giant Gastric
Mucormycotic Ulcer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
Kusum D. Jashnani, Pratibha Suryakant Shete, and Vandana
Rajesh Saravade
xi
xii Contents
9 Puerperal Sepsis: A Preventable Cause of
Maternal Death . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
Kusum D. Jashnani, Sakshi Agrawal, Lalita Yoganand Patil,
and Vandana Rajesh Saravade
10 Peripartum Cardiomyopathy: Failed
Cardiac Physiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
Rushabh Shah, Pranita Zare, and Pradeep Vaideeswar
1 1 HELLP Syndrome: The Snowball Effect . . . . . . . . . . . . . . . . . . . 51
Shilpa Kapil Lad, Kusum D. Jashnani, and Shekhar T. Nabar
1 2 Uterine Anomalies: Less Common but Lethal if
Not Detected! . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57
Kusum D. Jashnani, Sushama A. Chandekar,
and Reena J. Wani
1 3 Retained Products of Conception and
Dilatation and Curettage: A Cause for
Disseminated Intravascular Coagulation . . . . . . . . . . . . . . . . . . . 61
Kusum D. Jashnani, Sushama A. Chandekar,
and Rakesh R. Bhadade
Part II Indirect Maternal Deaths
14 Pulmonary Bone Marrow Embolism: The
Uncommon but Fatal Complication of Sickle Cell Disease . . . . . 69
Niyati N. Sangoi, Kusum D. Jashnani, Lalita Yoganand Patil,
and Vandana Rajesh Saravade
1 5 Neurocysticercosis, Pregnancy, and Albendazole:
The Unholy Trio . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75
Sweety Shinde, Kusum D. Jashnani, and Rosemarie de Souza
1 6 Lupus Nephritis and Pregnancy: Concern for
Both Mother and Fetus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79
Kusum D. Jashnani, Mamta Vasudev Kripalani,
Lalita Yoganand Patil, and Rakesh R. Bhadade
1 7 Disseminated Microthrombi in Pregnancy: Not
Always DIC, Think of TTP . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87
Sheetal Anil Ghugare, Kusum D. Jashnani,
Lalita Yoganand Patil, and Vandana Rajesh Saravade
1 8 HEV-Associated Hepatic Necrosis and Hepatic
Encephalopathy in Pregnancy: Should Hepatitis
E Virus Surveillance Be Made Mandatory in Pregnancy? . . . . . 93
Sushama A. Chandekar, Padmaja Vishwadeep Patil,
Kusum D. Jashnani, and Rosemarie de Souza
1 9 H1N1 Influenza in Pregnancy: Yet Another Dreaded Flu . . . . . . 97
Gayathri Prashant Amonkar and Kusum D. Jashnani