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IN THE NAME OF GOD

IN THE NAME OF GOD. A comparison of maternal autopsy & clinical diagnosis in Kermanshah , Iran 2007-2011. Fakheri Taravat Associate prof KUMS. Autopsy. Post-mortem examination . Highly specialized surgical exam. To determine the cause and manner of death.

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IN THE NAME OF GOD

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  1. IN THE NAME OF GOD

  2. A comparison of maternal autopsy & clinical diagnosis in Kermanshah , Iran 2007-2011 FakheriTaravat Associate prof KUMS

  3. Autopsy • Post-mortem examination . • Highly specialized surgical exam. • To determine the cause and manner of death. • To evaluate any disease or injury.

  4. "gold standard" for cause of death .

  5. Autopsy • Forensic autopsy ,cause of death criminal. • Clinical or academic autopsy, find medical cause of unknown or uncertain death, or research purposes.

  6. Autopsy • 1=External examination • 2=Body is dissected and internal examination is conducted. • Permission from next of kin may be required for internal autopsy in some cases. • When internal autopsy is complete the body is reconstituted by sewing it back together

  7. Verbal autopsy • As part of a demographic surveillance system by research institutions to collect records of births and deaths periodically among small populations (typically in a district).

  8. Verbal autopsy • Cause of death through interviews with family or community members • Medical certification of cause of death is not available.

  9. Verbal autopsy • Misclassification of causes of deaths. • Fail to identify , esp (EP, abortion-related) and indirect causes . • Requires physician assessment and long interviews. • Findings cannot be extrapolated to obtain national MMRs.

  10. Accuracy • 1=extent of family members’ knowledge of the events leading to the death, • 2=the skill of the interviewers, • 3=Competenceof physicians who do the diagnosis and coding. • The latter two factors are largely overcome by the use of software.

  11. Method &Material

  12. Descriptive, • Retrospective review • Postmortem autopsy • Cases of maternal committee death records • Kermanshah University of Medicine • 5-year period.

  13. All maternal mortality committee records • year 2007-2012 • Investigated and compared with the records of forensic medicine center records of autopsied patients. • Check list filled and assayed with the spss19.

  14. Findings

  15. 43 cases of autopsied maternal death registered.

  16. Frequency according to year

  17. Frequency according to age

  18. Frequency according to age • The average age of maternal death was 31.3±3.6 .

  19. Frequency according to place

  20. Frequency according to residence • 32 (74%) =Urban • 11(26%) =Rural

  21. Frequency according to residence

  22. Maternal mortality etiology

  23. Direct maternal mortality

  24. Autopsy finding Direct MM

  25. Indirect maternal mortality

  26. Autopsy finding Indirect MM

  27. The comparison of maternal autopsy & clinical diagnosis • In 39/43 or(90.6%) of cases there was concordance of clinical & autopsy finding & in only 4/43 or (9.4%) the diagnosis was different.

  28. Discussion

  29. Discordance • In our study the rate was 9.4% which is in accordance with the lowest reported rate. • 75% of discordance due to direct causes.

  30. Discordance • Mexico; 100% concordance in D cases, a 60% discordance in I cases. • Africa ; 34 of the 84 cases (38.1%). • false - ; infectious diseases, sensi< 50%: • false + ; Eclampsia, PPV =42.9%. • Japan ; AFE, septic DIC &birth canal injury • Africa; in 56 (40.3%) maternal deaths.

  31. Substantial discordance • 10% to more than 30% • To 40% of physician-certified deaths will be present in verbal autopsy data.

  32. Conclusion • What is now needed ? • In low- and middle-resource countries , robust studies of the concordance of verbal and diagnostic pathology autopsy to assess the contribution that diagnostic pathology autopsy can make to the quality of verbal autopsy and other mortality data.

  33. Conclusion • Continuous evaluation of deaths by diagnostic pathology autopsy in conjunction with verbal autopsy • Promote continuous quality assessment • Improvement of mortality data, • Facilitate the identification of new or emerging disease processes.

  34. WITH THANKS

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