1) Thromboembolism:

Changes in the clotting factors and venous stasis and thromboembolism (especially after cesarean section).

Thromboembolism may cause death in any of the trimesters of pregnancy.

Thrombolism may also occur after delivery (postpartum).High risk factors for postpartum thrombolism include age over 35 , obesity, post cesarean section.

Mutations in Factor V Leiden and heterozygous factor II can also increase the risk of venous thromboembolism in pregnancy.

The incidence of venous thromboembolism is much higher in women who have both Factor V and factor II mutations.

Increased use of prophylaxis (such as compression stockings in high risk women), can reduce the risk of thromboembolism.

Very high risk pregnant patients (such as patients with a family history and/or personal history of thromboembolism) must be on heparin prophylaxis.

Numerous studies have shown that the use unfractionated heparin (or low molecular weight heparin) with low dose aspirin throughout pregnancy improves fetal outcomes.

2)Haemorrhage:

Postpartum haemorrhage accounts for 50% of the cases of haemorrhage related to pregnancy. The remaining 50% is due to antepartum haemorrhage (This includes placenta praevia and abruptio placentae.) 25% are due to placenta praevia and the remaining 25% is due to abruptio placentae.

Placenta praevia

Placenta praevia is particularly dangerous if it is implanted over a uterine scar. Only a consultant or a senior registrar must carry out the cesarean section for placenta praevia.

Abruptio Placenta

Usually associated with severe pain, but may not have  bleeding per vaginum. Coagulopathy could complicate abruptio placenta.

Postpartum haemorrhage

This topic will be covered in numerous posts .All hospitals must have clear guidelines for the management of postpartum haemorrhage.

3) Hypertensive disorders in pregnancy:

Severe hypertensive disease usually presents around 32 weeks of gestation. Some of the complications of hypertensive disorders in pregnancy include intracranial haemorrhage, acute respiratory distress syndrome,pulmonary edema, cerebral edema etc.

4)Amniotic fluid embolism:

When amniotic fluid finds its way to the maternal circulation, there is a sudden severe reaction in the lungs. This can cause sudden collapse and death, usually during labour.

Proof of the diagnosis is by finding fetal squames in the mothers lungs at autopsy.

5)Puerperal Sepsis:

This is common in developing countries. Prophylactic antibiotics may be given in cesarean section. Prophylactic antibiotics are not recommended in normal vaginal delivery.

6)Deaths during early pregnancy:

This refers to deaths occuring before 24 weeks of gestation.

The common causes of death during this period include ectopic pregnancy, spontaneous abortion and termination of pregnancy.

Ectopic pregnancy presents as abdominal pain with a positive pregnancy test.This can progress to shock and death rapidly if not managed immediately.

7 Deaths due to anaesthesia

This is very rare these days, due to use of modern equipments and anaesthetics.

8)Death due to genital tract trauma

Such as uterine rupture and uterine perforation. This can follow instrumental vaginal delivery.

References:

Pages 175 to 181. Chapter 21. Thrombophilia in Pregnancy by Pankaj Desai and Purvi Patel. Medical Disorders in pregnancy-An Update. Edited by Hiralal Konar and Pralhad Kushtagi. Federation of obstetric and gynaecological societies of India.

Pages 20 to 32.Chapter 3. Maternal and Perinatal Mortality.Obstetrics by Ten Teachers.Seventeenth edition. Edited by Stuart Campbell and Christoph Lees.

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