Autopsy Of The Pregnant Woman

In 2003, the United States Death Certificate was revised to require information about the decedent’s gestational status at autopsy and in the year before death. Analysis of this information revealed a shocking and unexpected truth: previous statistical estimates of violent death in pregnancy were vastly underreported. The most common manner of death in American pregnant women is homicide. This work will cover a short history of death during pregnancy and childbirth, and review the studies which revealed the prevalence of fatal violence against pregnant women. The gross and anatomic findings in deaths due to natural causes will be reviewed including amniotic fluid embolus, hemorrhage, peripartum infection, and coronary artery dissection. Autopsy of the Pregnant Woman is distinguished from other works in the field not only by its subject matter, but also by inclusion of specific recommendations pertaining to proper dissection technique, report content and structure, the collection, storage, and transport of specimens for paternity testing, and methods of fetal aging. A valuable guide to the autopsy of the pregnant woman for forensic pathologists and trainees in current medico-legal practice. Outlines the dissection techniques, specimen collection protocols, and methods of fetal age determination necessary to generate a pathologically and legally sound autopsy report. Includes color photographs, both gross and microscopic, as well as schematics to clearly demonstrate autopsy techniques.

The book discusses about 45 cases of maternal autopsies. These maternal mortalities are related to pregnancy-related diseases, pre-existing diseases that worsen or manifest during pregnancy and diseases for which pregnant patient has increased risk. As the study of maternal mortality is a healthcare quality indicator and plays an important role in the improvement of obstetric care, the book aims at discussing autopsy findings, which is the gold standard for establishing not only the causes of death, but also to uncover the various pathological lesions produced by the physiologic phenomenon of pregnancy. This helps in identifying the direct and indirect causes, which can be reviewed at multidisciplinary review meetings. The chapters are arranged according to direct and indirect causes of maternal death, involving varied target organ systems i.e. central nervous system, cardiovascular system, respiratory system, gastro-intestinal tract, hepato-biliary system and pancreas, urinary system, female genital tract and others. However, it does not include diseases coincidental in pregnancy. Each case begins with the complete case history (age, duration of pregnancy, clinical presentation, investigations, clinical diagnosis, therapy, and course during ward stay, if any), autopsy findings, followed by a clinico-pathological discussion and includes appropriate gross organ and microscopic images. The book caters to the specialists in pathology, obstetrics, general medicine, critical care, surgery, pulmonologists, cardiology and all those involved in the care of pregnant women.

The evaluation of reproductive, maternal, newborn, and child health (RMNCH) by the Disease Control Priorities, Third Edition (DCP3) focuses on maternal conditions, childhood illness, and malnutrition. Specifically, the chapters address acute illness and undernutrition in children, principally under age 5. It also covers maternal mortality, morbidity, stillbirth, and influences to pregnancy and pre-pregnancy. Volume 3 focuses on developments since the publication of DCP2 and will also include the transition to older childhood, in particular, the overlap and commonality with the child development volume. The DCP3 evaluation of these conditions produced three key findings: 1. There is significant difficulty in measuring the burden of key conditions such as unintended pregnancy, unsafe abortion, nonsexually transmitted infections, infertility, and violence against women. 2. Investments in the continuum of care can have significant returns for improved and equitable access, health, poverty, and health systems. 3. There is a large difference in how RMNCH conditions affect different income groups; investments in RMNCH can lessen the disparity in terms of both health and financial risk.

The main objectives of this report are: to describe the current provincial and territorial activities to investigate and report on maternal deaths; to review and summarize available indiviual case-level reports of maternal deaths occurring in Canada between 1997 and 2000; to describe the occurrence and trends of severe maternal morbidity in Canada; to make recommendations to enhance the surveillance of maternal mortality and severe maternal morbidity in Canada.

Each year more than 4 million children are born with birth defects. This book highlights the unprecedented opportunity to improve the lives of children and families in developing countries by preventing some birth defects and reducing the consequences of others. A number of developing countries with more comprehensive health care systems are making significant progress in the prevention and care of birth defects. In many other developing countries, however, policymakers have limited knowledge of the negative impact of birth defects and are largely unaware of the affordable and effective interventions available to reduce the impact of certain conditions. Reducing Birth Defects: Meeting the Challenge in the Developing World includes descriptions of successful programs and presents a plan of action to address critical gaps in the understanding, prevention, and treatment of birth defects in developing countries. This study also recommends capacity building, priority research, and institutional and global efforts to reduce the incidence and impact of birth defects in developing countries.

The best way to grasp the essence of death scene investigation (DSI) is to witness its application, called the psychological autopsy, by an expert forensic scientist/clinician. This remarkable book affords the opportunity to delve into the challenges that the forensic mental health specialist and public safety professional confront in DSI. Suicides, and often death, are complex, multidetermined events. People, whether police investigators or mental health professionals, are generally perplexed, and even confused, when they are confronted by the equivocal case. Was it a suicide? Homicide? Accident? These are critical questions. Dr. Leenaars shows that DSI is, however, not mysterious; the reader can learn the generally accepted, evidence-based protocols of the psychological autopsy. Illuminated by individual (idiographic) case studies and general (nomothetic) research, this definitive guide allows the investigator to uncover the bare bones of a suicide or death.

This User’s Guide is intended to support the design, implementation, analysis, interpretation, and quality evaluation of registries created to increase understanding of patient outcomes. For the purposes of this guide, a patient registry is an organized system that uses observational study methods to collect uniform data (clinical and other) to evaluate specified outcomes for a population defined by a particular disease, condition, or exposure, and that serves one or more predetermined scientific, clinical, or policy purposes. A registry database is a file (or files) derived from the registry. Although registries can serve many purposes, this guide focuses on registries created for one or more of the following purposes: to describe the natural history of disease, to determine clinical effectiveness or cost-effectiveness of health care products and services, to measure or monitor safety and harm, and/or to measure quality of care. Registries are classified according to how their populations are defined. For example, product registries include patients who have been exposed to biopharmaceutical products or medical devices. Health services registries consist of patients who have had a common procedure, clinical encounter, or hospitalization. Disease or condition registries are defined by patients having the same diagnosis, such as cystic fibrosis or heart failure. The User’s Guide was created by researchers affiliated with AHRQ’s Effective Health Care Program, particularly those who participated in AHRQ’s DEcIDE (Developing Evidence to Inform Decisions About Effectiveness) program. Chapters were subject to multiple internal and external independent reviews.