DIRECT CAUSES OF MATERNAL DEATH AN AUTOPSY STUDY.

Background: Autopsy is an important tool in the investigation of maternal death. It provides valuable information about pathophysiological changes in various organs which may be important in the delineation of the sequence of events leading to maternal death.The present study was conducted at Department of forensic medicine, Government Medical College, Thiruvananthapuram,Kerala during 1995 January to April 2003.The circumstances which lead to medico legal autopsy in maternal deaths were , cases either brought dead to casualty , referred due to obstetrical complications from distant hospitals, and allegations of medical negligence in the care and management by relatives which later turn into a medico legal case.. Aim: 1. To detect the spectrum of causes leading to maternal death subjected to medico legal autopsy 2. To identify the direct causes of maternal deaths 3. To suggest measures to prevent maternal deaths Materials and methods: Sixty-five cases brought for Medico legal autopsy during the period from January1995 to April 2003 were included in the present retrospective/ prospective study. Result: 31 cases (48%) of maternal deaths were in the age group 25-29 years, and most were primigravida. Direct maternal death were the leading cause in 39 cases( 60%) , among them haemorrhage was the prime cause of death, i.e. 15 cases ( 23%) . 24 cases ( 36.9%) were due to indirect causes and 2 cases were fortuitous deaths. Conclusion: Death following obstetric haemorrhage remains the prime direct cause of maternal death, which can be tackled by active management of third and fourth stage of labour. A multidisciplinary approach with regular audit, mortality conferences, promoting autopsy in maternal death will help to identify the causes and to prevent maternal deaths. Though the risk of death from complications of pregnancy has decreased during the past few decades in India, it continues to remain higher in other developing countries.