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Review
. 2021 Apr;71(4):223-231.
doi: 10.1111/pin.13076. Epub 2021 Feb 9.

Maternal death analysis based on data from the nationwide registration system in Japan (2010-2018)

Tomoko Wakasa  1 , Hatsue Ishibashi-Ueda  2 , Makoto Takeuchi  3
Affiliations
Review

Maternal death analysis based on data from the nationwide registration system in Japan (2010-2018)

Tomoko Wakasa et al. Pathol Int. 2021 Apr.

Abstract

The maternal mortality rate in Japan was 3.5 per 100 000 live births in 2017, similar to that reported in other developed countries. To reduce the number of maternal deaths, a Japanese nationwide registration and analysis system was implemented in 2010. Between January 2010 and April 2018, 367 maternal deaths were reported. Among them, by reviewing 80 autopsy records, the direct obstetric causes of death were identified in 52 women. The major causes of deaths were amniotic fluid embolism and acute pulmonary thromboembolism. The other 26 maternal deaths were associated with indirect obstetric causes including invasive Group A Streptococcus infection, aortic dissection, cerebral stroke and cardiomyopathies. This review highlights the importance of autopsy in maternal deaths. On analyzing 42 autopsy specimens obtained from registered cases of maternal death during 2012-2015, the 36% of causes of death by autopsy were discordant with the clinical diagnosis. Moreover, of the 38% of non-autopsied maternal death, the cause of death could not be clarified from the clinical chart. We emphasized that detailed autopsies are necessary to clarify the precise pathologic evidence related to pregnancy and delivery, especially causes of unexpected death such as amniotic fluid embolism.

Keywords: amniotic fluid embolism; autopsy; maternal death; nationwide registration; pregnancy.

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Figures

Figure 1
Figure 1
Amniotic fluid embolism in an autopsied maternal lung. (a) Image showing the fetal debris in the pulmonary arterioles. (arrow). (b) Serial section of Fig. 1a stained with Alcian blue. In the pulmonary artery, mucin as fetal components were identified (arrow).
Figure 2
Figure 2
Immunohistochemistry of amniotic fluid embolism in an autopsied lung. (a) Fetal skin fragments stained positively with the broad‐spectrum anti‐pancytokeratin cocktail (AE1/AE3) are shown, and alveolar pneumocytes are shown as a positive control. (b) Cytokeratin‐1‐positive fetal skin fragments in pulmonary arterioles.
Figure 3
Figure 3
A representative case of amniotic fluid embolism in an autopsied uterus. (a) Thrombus around the fetal component in a venule of the uterus (arrow). The image shows intravascular coagulation due to the fetal debris. (b) The serial section of Fig. 3a. The fetal debris in the venules of the uterus show positive staining with the broad‐spectrum anti‐pancytokeratin cocktail (AE1/AE3).
Figure 4
Figure 4
Recent trends in autopsy rates (2010–2017: analyzed cases).
See this image and copyright information in PMC

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