Shruti Chandrakar

Abstract

Aims: The main objective is to study the gross pathology and microscopy of all organs in cases of maternal death, establish clinico-pathological correlation, to ascertain the exact cause of death and classify them into direct or indirect causes. Settings and Design: Cross sectional study of all medical autopsies. Materials and Methods: A cross sectional study of all medical autopsies performed on deaths related to pregnancy at our tertiary care hospital over a period of four years. A total of 100 cases were studied. Maternal mortality autopsies where medico legal implications were involved or unnatural deaths not related to pregnancy were excluded from the study. Statistical Analysis used: Nil Results: The maximum no. of maternal deaths occurred in the age group 20-24 years (45%) followed by 30-34 years (19%). 62% of patients in our study were multigravidae. Majority of maternal deaths were seen in the postpartum period (75%). In the antepartum period maximum number of maternal deaths occurred in 3rd trimester (14%) Our study revealed majority of maternal deaths were due to indirect causes (76%), Pregnancy induced hypertension was the most common direct cause of death (9%). The majority of cases were due to infectious aetiology (45%), while the other indirect causes were sepsis (14%), coagulopathy (8%) and hemodynamic (8%). Conclusion: The higher MMR in our study could be attributed to the fact that ours being a tertiary and referral care hospital, where patients are referred late and most of them are complicated cases and in serious condition at the time of admission. The low socioeconomic status of the patients, delay in referral and non-utilisation of the available antenatal care could be the major contributing factors. Our study revealed majority of maternal deaths were due to indirect causes especially respiratory infections and hepatitis Increased incidence of indirect causes reflect the present health care system. So adequate prenatal testing for these causes (infections), improving the nutritional status, sanitation can help in lowering the maternal mortality rate. Keywords: Autopsy, Maternal death.

Open full article page

Abstract

A spectrum of renal pathology is observed during pregnancy, so our main objective was to study the gross pathology and microscopy of the kidney in cases of maternal death, and to establish a clinico-pathological correlation. This was a cross-sectional study of all medical autopsies performed on deaths related to pregnancy at our tertiary care hospital over a period of 7 years. In 166 autopsies, pathology was observed in 42 cases, and the kidneys were unremarkable in 124 cases. The most common renal pathology observed was acute tubular necrosis (22 cases), followed by acute pyelonephritis (7 cases), disseminated intravascular coagulation with fibrin thrombi (7 cases), diabetic nephropathy (3 cases), sickle cell anemia (1 case), tuberculosis kidney (1 case), and thrombotic microangiopathy (1 case). Renal pathology was observed in 25.3% of autopsies performed on maternal death, which contributed to a significant number of maternal mortalities and morbidities. The incidence of acute renal failure was 14.28% in our study. Apart from obstetric complications (e.g. antepartum hemorrhage, postpartum hemorrhage, pregnancy-induced hypertension), infections (e.g. pyelonephritis) were associated with septicemia, deranged renal function tests, and acute renal failure. Keywords: Autopsy, Maternal Death, Renal Pathology.

Open full article page

Abstract

Introduction: Secondary AA amyloidosis is a classical complication of chronic inflammatory conditions like rheumatoid arthritis, ankylosing spondylitis and inflammatory bowel disease or chronic infectious diseases like tuberculosis, bronchiectasis and chronic osteomyelitis. Amyloidosis is an extremely rare complication of psoriatic arthritisand is associated with a poor prognosis.1-3 Materials and Methods: We report a case of a 42 year old male, a known case of psoriasis since 1 year and on methotrexate 15mg /day since 6 month in view of psoriatic arthropathy. Laboratory findings revealed urinary spot protein in the nephrotic range along with hyperlipidemia, hypoproteinemia and albuminuria suggestive of nephrotic syndrome. USG guided renal biopsy revealed renal amyloidosis with congo red positivity showing apple green birefringence. Patient expired within 48 hours after renal biopsy due to pneumonia. Complete autopsy was performed and histopathology showed amyloidosis restricted to the kidneys. Result: USG guided renal biopsy revealed renal amyloidosis with congo red positivity showing apple green birefringence. Patient expired within 48 hours after renal biopsy due to pneumonia. Complete autopsy was performed and histopathology showed amyloidosis restricted to the kidneys. Conclusion: Amyloidosis should be considered in patients with long-standing severe psoriasis and psoriatic arthropathy who develop renal symptoms and there can be rapid onset of amyloidosis after the first articular signs. Prognosis is usually poor. Keywords: Psoriatic nephropathy, Renal amyloid, Secondary amyloidosis.  

Open full article page