Clinicopathological and histopathological spectrum of hysterectomy specimens in autopsy

Krupa Akbari; Ami Jagirdar

doi:10.18203/2320-6012.ijrms20264189

Authors

Krupa Akbari Department of Pathology, Surat Municipal Institute of Medical Education and Research, Surat, Gujarat, India
Ami Jagirdar Department of Pathology, Surat Municipal Institute of Medical Education and Research, Surat, Gujarat, India

DOI:

https://doi.org/10.18203/2320-6012.ijrms20264189

Keywords:

Hysterectomy, Autopsy, Obstetric causes, Histopathology

Abstract

Background: This study evaluated the clinicopathological and histopathological spectrum of hysterectomy specimens at autopsy remains the gold standard for identifying the precise cause of death.

Methods: A retrospective observational study of 28 autopsy hysterectomy cases was conducted between 2024- 2026 (2.5 years) at SMIMER Medical College, Surat, Gujarat. Demographic profiles, obstetric characteristics, and histopathological findings were analyzed using descriptive statistics.

Results: The median age was 31.5 years, with 60.7% (n=17) aged >30 years. Maternal deaths accounted for 67.9% (n=19), while 32.1% (n=9) were non-gestational fatalities. Of the maternal deaths, 42.1% (n=8) collapsed antepartum while undelivered. Direct obstetric causes caused 63.2% (n=12) of maternal deaths, primarily driven by obstetric hemorrhage and morbid placental adherence (17.9%, n=5) and hypertensive disorders (14.3%, n=4). Other causes included spinal anesthesia toxicity (7.1%, n=2), sepsis (3.6%, n=1), indirect medical conditions (connective tissue disease, sickle cell crisis), and non-gestational etiologies (poisoning, cervical malignancy).

Conclusions: Preventable complications, predominantly direct obstetric causes (hemorrhage, preeclampsia) remain leading causes of mortality, particularly in women over 30 years. Microscopic evaluation of hysterectomy specimens is crucial for identifying occult pathology and strengthening maternal death audits.

References

World Health Organization. Maternal mortality. Fact sheet. Geneva: World Health Organization. 2024. Available at: https://www.who.int/news-room/fact-sheets/detail/maternal-mortality. Accessed on 15 September 2026.

World Health Organization, UNICEF, UNFPA, World Bank Group, United Nations Population Division. Trends in maternal mortality 2000 to 2023: estimates by WHO, UNICEF, UNFPA, World Bank Group and UNDESA/Population Division. Geneva: World Health Organization. 2024.

Say L, Chou D, Gemmill A, Tunçalp Ö, Moller AB, Daniels J, et al. Global causes of maternal death: a WHO systematic analysis. Lancet Glob Health. 2014;2(6):e323-33.

Cresswell JA, Alexander M, Chong MY, Heather ML, Marija P, Ursula G, et al. Global and regional causes of maternal deaths 2009-20: a WHO systematic analysis. Lancet Glob Health. 2025;13(4):e626-34.

Verma A, Sivasankary R, Bansal S, Soibam N, Kumar A, Sihag N, Meshram R. Autopsy-based insights into maternal mortality: a retrospective study from a tertiary care center in North India. Cureus. 2026;18(4):e108077.

Montgomery AL, Ram U, Kumar R, Jha P. Maternal mortality in India: causes and healthcare service use based on a nationally representative survey. PLoS One. 2014;9(1):e83331.

Gavali SB, Chopdar A, Kulkarni KK, Kavatkar A, Nakate LA. Pathological aspects of maternal mortality: a tertiary care centre based study. J Popul Ther Clin Pharmacol. 2024;31(3):2281-8.

Poflee SV, Patil RN, Raut WK. Pathological study of maternal deaths-experience from a tertiary care centre in Central India. Int J Contemp Med Res. 2020;7(2):B9-13.

Panchabhai TS, Patil PD, Shah DR, Joshi AS. An autopsy study of maternal mortality: a tertiary healthcare perspective. J Postgrad Med. 2009;55(1):8-11.

Jashnani KD, Rupani AB, Wani RJ. Maternal mortality: an autopsy audit. J Postgrad Med. 2009;55(1):12-6.

Walke VA, Datar S, Dhote AR, Gaikwad A, Toshniwal A, Kowe B. An insight into maternal deaths: a retrospective analysis and pathologists perspective in series of 16 autopsy cases. J Clin Diagn Res. 2022;16(6):EC01-5.

Kavatkar AN, Sahasrabudhe NS, Jadhav MV, Deshmukh SD. Autopsy study of maternal deaths. Int J Gynaecol Obstet. 2003;81(1):1-8.

Debbarma S, Jashnani K, Patil L, Sangoi N. Provisional versus final cause of maternal death on autopsy: exploring the gaps. Am J Forensic Med Pathol. 2025;46(1):1088.

Shubhendu K, Mundri S, Kumar S, Kumar A. The impact of histopathology on medical board autopsies. Cureus. 2025;17(1):e78675.

Lopez JMT. Histopathology in medico-legal autopsies: clinical foundation, legal mandate, and judicial guarantee. J Forensic Leg Med. 2025;109:102974.

Pawar PM, Jujgar AS, Gosavi AV, Momin YA, Kolekar SH. Histopathological study of direct causes of maternal deaths. Indian J Obstet Gynecol Res. 2025;12(3):547-54.

Hecht JL, Ordi J, Carrilho C, Ismail MR, Zsengeller ZK, Karumanchi SA, et al. The pathology of eclampsia: an autopsy series. Hypertens Pregnancy. 2017;36(3):259-68.

Office of the Registrar General, India. Sample Registration System (SRS) special bulletin on maternal mortality in India 2020-2022. New Delhi: Office of the Registrar General, Ministry of Home Affairs, Government of India. 2023.

Dol J, Hughes B, Bonet M, Dorey R, Dorling J, Grant A, et al. Timing of maternal mortality and severe morbidity during the postpartum period: a systematic review. JBI Evid Synth. 2022;20(9):2119-94.