The Minimally Invasive Autopsy is a Valid Technique to Determine Causes of Maternal Death

The minimally invasive autopsy is a promising tool to determine the causes of maternal death, especially for indirect obstetric conditions most of which are infectious diseases, according to a study published in PLOS Medicine and led by ISGlobal, an institution supported by the “la Caixa” Foundation. The information provided by this technique could help guide interventions aimed at reducing maternal deaths and monitor progress towards achieving the sustainable development goals (SDGs) proposed by the UN in 2015.   

Maternal mortality rates have dropped over the last decades, but remain unacceptably high in large regions of the world. In low-income countries, there were 230 maternal deaths per 100,000 live births in 2015. The SDG on maternal health aims to reduce this number to less than 70 per 100,000 by 2030.  This requires robust data sources that allow a better understanding of the real causes of maternal death in countries where most of these deaths happen. Verbal autopsies, currently used in low-resource settings to determine the cause of death, are poorly reliable; therefore, accurate but feasible and acceptable postmortem methods are needed.  

In this study, the authors used a minimally invasive autopsy (MIA) technique, previously validated in adults, children, neonates and stillbirths, to determine causes of maternal death. They performed paired MIA and complete diagnostic autopsies (considered as the gold-standard) on 57 maternal deaths that occurred at the Maputo Central Hospital, Mozambique. The complete autopsy determined the cause of death in 98% of cases, versus 86% determined by the MIA.  The most common cause of death among direct obstetric conditions was post-partum hemorrhage, while the most common indirect cause of death were infectious diseases, accounting for 57% of all deaths. Concordance between the MIA and the complete autopsy was good, particularly for indirect conditions (91%); and, in the case of infectious causes, MIA identified the pathogen in 2 of 3 cases (M. tuberculosis and P. falciparum were among the most common). In contrast, the concordance between the two methods was lower for direct obstetric causes of death (38%); although the authors point out that this could be improved by including information from the clinical history or the verbal autopsy.

The study concludes that the MIA represents a valuable tool to determine causes of maternal death, especially for infections and other indirect conditions. “The information provided by this technique could help plan and prioritize interventions aimed at reducing maternal mortality in low-income countries”, says Jaume Ordi, who coordinated the study together with Clara Menéndez and Quique Bassat. 

Reference

Castillo P, Hurtado JC, Martínez M et al. Validity of a minimally invasive autopsy for cause of death derermination in maternal deaths in Mozambique: An observational study. Plos Medicine. Nov 8, 2017. https://doi.org/10.1371/journal.pmed.1002431