Maternal mortality in Slovenia: Case report and the method of identifying pregnancy-associated deaths

Abstract

We report on the case of fatal intracerebral haemorrhage that followed the development of severe preeclampsia/eclampsia with haemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome in a 22-year-old primipara. Peculiarities of the reported case are abrupt onset of preeclampsia/eclampsia during the delivery, fulminant course of the disease, minimal changes in kidneys and signs of pre-existing accelerated arteriosclerosis. Since very few forensic pathologists have sufficient experience with such cases and the differential diagnosis may be difficult, we consider it necessary that in all maternal deaths the post-mortem examination is performed by a team of two forensic pathologists and the case further analysed in collaboration with expert obstetrician.

Maternal deaths are rare in developed countries but extremely important, because they represent the “tip of the iceberg” of severe maternal and neonatal morbidity and because they reflect accessibility and quality of prenatal and obstetric care as well as the health status of reproductive-aged women. Unfortunately, they are often misclassified in death certificates which may lead to insufficient engagement in solving underlying problems. In Slovenia, the method of active search for pregnancy-associated deaths is used in order to enable accurate monitoring of maternal mortality and minimise underreporting. The method is based on the manual revision of death certificates and the computer-based linkage of Mortality Database with birth register and foetal deaths register and has proved to be highly efficient.