Indirect causes of maternal deaths (except stroke, cardiovascular diseases and infections) in France 2016-2018

Maternal deaths from indirect obstetric cause result from a preexisting condition or a condition that occurred during pregnancy without obstetric causes but was aggravated by the physiological effects of pregnancy. Twenty-nine deaths with an indirect cause related to a preexisting condition, excluding circulatory diseases or infections, were analysed by the expert committee. Pre-pregnancy pathology was documented in 16 women (epilepsy, n = 7; amyloid angiopathy, n = 1; Dandy-Walker syndrome, n = 1; autoimmune diseases, n = 3; diffuse infiltrative pneumonitis, n = 1; thrombotic thrombocytopenic purpura, n = 1; ovarian cancer in fragile X, n = 1; major sickle cell disease, n = 1). In 13 women, the Gynecologie Obstetrique Senologie (2024) pathology was unknown before pregnancy (breast cancer, n = 9, epilepsy diagnosed during pregnancy, n = 1, brain tumours, n = 2 meningioma type, macrophagic activation syndrome, n = 1). Death was associated with neoplastic or tumour pathology in 13 women (45%). At the same time, epilepsy was responsible for the death of 8 women (27%), making it the most common cause of death. For both neoplasia and epilepsy, about 50% of deaths were preventable, mainly due to undiagnosed and/or delayed treatment in the case of cancer and failure to monitor or adjust treatment in the case of epilepsy. Pre-conception counselling is therefore strongly recommended if a woman has a known chronic medical condition prior to pregnancy. Finally, if there is a family history of breast cancer, a breast examination strongly recommended from the first visit during pregnancy, and any breast lumps should be investigated as soon as possible to avoid delaying appropriate treatment. (c) 2024 The Authors. Published by Elsevier Masson SAS. This is an open access article under the CC BY-NC ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).