Maternal death analysis based on data from the nationwide registration system in Japan (2010–2018)

Wakasa, T.; Ishibashi‐Ueda, Hatsue; Takeuchi, Makoto

doi:10.1111/pin.13076

Cited by 5 publications

(6 citation statements)

References 36 publications

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“…These findings strongly support the notion that an influx of amniotic fluid materials in the maternal circulation induces maternal inflammatory and anaphylactoid reactions in AFE. However, there is little pathological evidence to suggest haemostatic alteration in AFE, except for the above description 19–21 . The present study provides pathological evidence that amniotic fluid material that enters the uterine venous circulation induces platelet aggregation and activates the coagulation cascade, resulting in thrombus formation.…”

Section: Discussionmentioning

confidence: 55%

“…However, there is little pathological evidence to suggest haemostatic alteration in AFE, except for the above description. [19][20][21] The present study provides pathological evidence that amniotic fluid material that enters the uterine venous circulation induces platelet aggregation and activates the coagulation cascade, resulting in thrombus formation. However, the uterine venous thrombi were not observed in half of the AFE cases.…”

Section: Discussionmentioning

confidence: 78%

“…There is limited information on thrombus formation in AFE. An account on cardiovascular pathology 19 and previous reports 6,20 on AFE described pulmonary microthrombi and uterine venous thrombi with squamous epithelial emboli. We previously reported an autopsy case (No.…”

Section: Discussionmentioning

confidence: 94%

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Massive platelet‐rich thrombus formation in small pulmonary vessels in amniotic fluid embolism: An autopsy study

Yamashita

Oda

Aman

et al. 2023

BJOG

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ObjectiveTo identify pulmonary/uterine thrombus formation in amniotic fluid embolism (AFE).DesignRetrospective, observational.SettingNationwide.PopulationEleven autopsy cases of AFE and control cases.MethodsWe assessed pulmonary and uterine thrombus formation and thrombus area in AFE and pulmonary thromboembolism (PTE) as a control. The area of platelet glycoprotein IIb/IIIa, fibrin, neutrophil elastase, citrullinated histone H3 (a neutrophil extracellular trap marker) and mast cell chymase immunopositivity was measured in 90 pulmonary emboli, 15 uterine thrombi and 14 PTE.Main outcome measuresPathological evidence of thrombus formation and its components in AFE.ResultsAmniotic fluid embolism lung showed massive thrombus formation, with or without amniotic emboli in small pulmonary arteries and capillaries. The median pulmonary thrombus size in AFE (median, 0.012 mm2; P < 0.0001) was significantly smaller than that of uterine thrombus in AFE (0.61 mm2) or PTE (29 mm2). The median area of glycoprotein IIb/IIIa immunopositivity in pulmonary thrombi in AFE (39%; P < 0.01) was significantly larger than that of uterine thrombi in AFE (23%) and PTE (15%). The median area of fibrin (0%; P < 0.001) and citrullinated histone H3 (0%; P < 0.01) immunopositivity in pulmonary thrombi in AFE was significantly smaller than in uterine thrombi (fibrin: 26%; citrullinated histone H3: 1.1%) and PTE (fibrin: 42%; citrullinated histone H3: 0.4%). No mast cells were identified in pulmonary thrombi.ConclusionsAmniotic fluid may induce distinct thrombus formation in the uterus and lung. Pulmonary and uterine thrombi formation may contribute to cardiorespiratory collapse and/or consumptive coagulopathy in AFE.

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Section: Discussionmentioning

confidence: 55%

Section: Discussionmentioning

confidence: 78%

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Massive platelet‐rich thrombus formation in small pulmonary vessels in amniotic fluid embolism: An autopsy study

Yamashita

Oda

Aman

et al. 2023

BJOG

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“…5,6 Surprisingly, a recent report demonstrated that the prevalence of self-harm death between 2005 and 2014 in Tokyo, Japan (8.7/100 000 women) was much higher than that reported previously (2.8/100 000 women in 2014 on average in Japan). 5 In addition, this is higher than the prevalence of obstetric-related maternal deaths, including stroke, postpartum hemorrhage, amniotic fluid embolism, and peripartum thromboembolism (3.5/100 000 women in Japan in 2017), 5,7,8 and is also higher than that in other countries (1.3-5.9/100 000 women in Europe and the United States). 5,9,10 As perinatal mental health care is of growing importance, the identification of women at high risk of PPD in advance is necessary to provide timely therapeutic intervention and social support.…”

Section: Introductionmentioning

confidence: 95%

Machine learning prediction models for postpartum depression: A multicenter study in Japan

Matsuo

Ushida

Emoto

et al. 2022

J of Obstet and Gynaecol

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Aim Postpartum depression (PPD) and perinatal mental health care are of growing importance worldwide. Here we aimed to develop and validate machine learning models for the prediction of PPD, and to evaluate the usefulness of the recently adopted 2‐week postpartum checkup in some parts of Japan for the identification of women at high risk of PPD. Methods A multicenter retrospective study was conducted using the clinical data of 10 013 women who delivered at ≥35 weeks of gestation at 12 maternity care hospitals in Japan. PPD was defined as an Edinburgh Postnatal Depression Scale score of ≥9 points at 4 weeks postpartum. We developed prediction models using conventional logistic regression and four machine learning algorithms based on the information that can be routinely collected in daily clinical practice. The model performance was evaluated using the area under the receiver operating characteristic curve (AUROC). Results In the machine learning models developed using clinical data before discharge, the AUROCs were similar to those in the conventional logistic regression models (AUROC, 0.569–0.630 vs. 0.626). The incorporation of additional 2‐week postpartum checkup data into the model significantly improved the predictive performance for PPD compared to that without in the Ridge regression and Elastic net (AUROC, 0.702 vs. 0.630 [p < 0.01] and 0.701 vs. 0.628 [p < 0.01], respectively). Conclusions Our machine learning models did not achieve better predictive performance for PPD than conventional logistic regression models. However, we demonstrated the usefulness of the 2‐week postpartum checkup for the identification of women at high risk of PPD.

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“…Up to 10% of pregnant individuals will experience some form of mental condition, some of which can have a lethal outcome . As maternal death due to critical obstetric hemorrhage has decreased worldwide, possibly through improvements in medical practice, equipment, and blood supply systems, the maternal death rate by suicide has increased. Suicidal death is currently considered to account for 5% to 20% of maternal mortality in developed countries, but the exact risks of peripartum suicide attempts remain largely unknown.…”

Section: Introductionmentioning

confidence: 99%

Risk Factors Associated With Peripartum Suicide Attempts in Japan

et al. 2023

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ImportancePeripartum suicide attempt is a major psychiatric complication associated with pregnancy, but the risk factors remain largely uncertain.ObjectiveTo identify the demographic characteristics and predisposing risks for peripartum suicide attempts and postpartum depression.Design, Setting, and ParticipantsThis cohort study used retrospective data on pregnant women who delivered children between April 1, 2016, and March 31, 2021, at 712 hospitals in Japan. The nationwide Diagnosis Procedure Combination database was used.ExposuresPsychiatric and nonpsychiatric medical history, age, alcohol and tobacco use, and obstetric complications and procedures.Main Outcomes and MeasuresData on admissions for prepartum suicide attempt and delivery during the same hospital stay and readmissions for depression or suicide attempt within 1 year post partum were collected. Comparisons of prevalence of each study variable were performed, and multivariable logistic regression analyses were used to determine risk factors.ResultsFrom a total of 39 908 649 hospitalization episodes, 804 617 cumulative pregnant women (median [IQR] age at childbirth, 33 [29-36] years) who delivered at the enrolled hospitals were identified, including 1202 who were admitted for suicide attempt and delivery during the same hospital stay and 111 readmitted for suicide attempt within 1 year post partum. Risk factors associated with prepartum suicide attempts included younger age (adjusted odds ratio [aOR], 0.99; 95% CI, 0.98-1.00) and histories of personality disorder (aOR, 10.81; 95% CI, 5.70-20.49), depression (aOR, 3.97; 95% CI, 2.35-6.70), schizophrenia (aOR, 2.89; 95% CI, 1.52-5.50), and adjustment disorder (aOR, 2.66; 95% CI, 1.07-6.58). Risk factors associated with postpartum suicide attempts included younger age (aOR, 0.96; 95% CI, 0.93-1.00), heavy tobacco use (aOR, 23.09; 95% CI, 5.46-97.62), and histories of alcohol use disorder (aOR, 163.54; 95% CI, 28.30-944.95), personality disorder (aOR, 10.28; 95% CI, 3.29-32.10), anxiety disorders (aOR, 8.13; 95% CI, 2.88-22.98), depression (aOR, 7.27; 95% CI, 2.95-17.91), schizophrenia (aOR, 5.77; 95% CI, 2.17-15.38), bipolar disorder (aOR, 3.98; 95% CI, 1.36-11.67), and insomnia (aOR, 3.17; 95% CI, 1.30-7.78). On sensitivity analysis, risk factors associated with postpartum depression after excluding those with prenatal depression included histories of personality disorder, adjustment disorder, bipolar disorder, insomnia, and anxiety disorders.Conclusions and RelevanceThe findings of this cohort study suggest that histories of smoking and prenatal psychiatric disorders are potential risk factors for peripartum suicide attempts and may require additional treatment and prevention interventions.

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Maternal death analysis based on data from the nationwide registration system in Japan (2010–2018)

Cited by 5 publications

References 36 publications

Massive platelet‐rich thrombus formation in small pulmonary vessels in amniotic fluid embolism: An autopsy study

Massive platelet‐rich thrombus formation in small pulmonary vessels in amniotic fluid embolism: An autopsy study

Machine learning prediction models for postpartum depression: A multicenter study in Japan

Risk Factors Associated With Peripartum Suicide Attempts in Japan

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