Pregnancy related deaths: A ten year retrospective study in the mortuary of a tertiary care teaching hospital of northeast India

An audit of autopsies of pregnancy related deaths is important for the establishment of accurate cause of delivery deaths and to determine whether there is existence of negligence or not to the various cases. The present study was aimed at finding out the factors which are associated with pregnancy related deaths that underwent autopsy in the mortuary of a tertiary care teaching hospital of northeast India during the period of 2006 to 2015. Autopsy records with clinical notes were retrieved and histopathology slides were studied to establish the accurate cause of delivery deaths. The variables like age (years), gravidity, pregnancy outcome, obstetrical characteristics, period of gestation, methods of delivery, death of patients after delivery, and place of deaths were used to classify and analyze the data from autopsy. There were altogether 14 cases of pregnancy related deaths and their age ranged from 18 years to 39 years. Of this, 12 were related with delivery. Four died due to shock and haemorrhage caused by uterine atony (28.6%), 4 due to cervical tear (28.6%) which could have been prevented with proper obstetrical procedure. Two died of uterine rupture (14.3%) at 40 weeks and 38 weeks, respectively, indicating a possibility of intervention at about 36 weeks or so. One died due to slippage of ligature (7.1%) and one due to amniotic fluid embolism (7.1%). The remaining 2 were of MTP and a natural death, (bronchopneumonia associated with pregnancy) respectively. Eight died in Hospital, 3 in Nursing home, 2 at home and 1 on the way to hospital. In conclusion, delay in diagnosis, treatment and decision to transfer, delay in transport for reaching to proper hospital and delayed therapy are the main factors these maternal deaths.