Pregnancy-related maternal deaths due to cardiovascular diseases in Japan from 2010 to 2019: an analysis of maternal death exploratory committee data

Figures & data

Table 1. Characteristics of maternal deaths due to cardiac disease (n = 44).

	N (%)
Age	32.1 [19–41]
Parity
Nulliparas	23 (52.3)
Multiparas	21 (47.7)
Maternal death category
Direct maternal death^a	9 (20.5)
Indirect maternal death^a	34 (77.3)
Late maternal death^b	1 (2.3)
Types of CVD
Aortic dissection	18 (40.9)
Peripartum cardiomyopathy	8 (18.2)
Pulmonary hypertension	5 (11.4)
Coronary diseases	4 (9.1)
Arrythmia	4 (9.1)
Myocarditis	3 (6.8)
Valve disease	1 (2.3)
Others	1 (2.3)
Congenital heart disease	0 (0.0)
Delivery
Undelivered	14 (31.8)
Vaginal delivery	13 (29.5)
Cesarean delivery	17 (38.6)

Age, mean age [min-max].

CVD: cardiovascular disease.

^aDirect and indirect maternal death: Deaths with a direct causal link to pregnancy status and deaths for which pregnancy status is unrelated to the cause of death (International Statistical Classification of Diseases and Related Health Problems, 10^th Revision [ICD-10] definition) [15].

^bLate maternal death: the death of a woman occurred >42 days but <1 year after termination of pregnancy [15].

Figure 1. The length of time between the occurrence of the first symptom and CPA according to diagnosis. PPCM: peripartum cardiomyopathy; CPA: cardiopulmonary arrest.

Table 2. Disease-specific characteristics of maternal deaths due to cardiac disease.

Types of CVD	Total (N = 44)	Aortic dissection (N = 18)	Peripartum cardiomyopathy (N = 8)	Pulmonary hypertension (N = 5)	Coronary diseases (N = 4)	Arrythmia (N = 4)	Myocarditis (N = 3)	Valve disease (N = 1)	Others (N = 1)
Occurrence of first symptoms
Prenatal	27 (61.4)	11	2	5	2	3	3	1	0
First trimester	5 (11.4)	0	0	0	0	2	2	1	0
Second trimester	6 (13.6)	3	0	2	0	1	0	0	0
Third trimester	16 (36.4)	8	2	3	2	0	1	0	0
During labor	3 (6.8)	1	0	0	1	0	0	0	1
Postpartum	13 (29.5)	6	6	0	1	0	0	0	0
Late (>6 weeks)	1 (2.3)	0	0	0	0	1	0	0	0
First symptoms
Respiratory symptoms^a	12 (27.3)	0	6	4	1	0	0	1	0
Pain^b	12 (27.3)	9	1	0	1	0	0	0	1
CPA	6 (13.6)	4	0	0	0	1	1	0	0
Unconscious	5 (11.4)	3	0	0	0	1	1	0	0
Risk factors
Age > 35	17 (38.6)	8	2	2	2	2	0	0	1
Hypertensive disorder	7 (15.9)	1	5	1	0	0	0	0	0
Obesity BMI > 30	7 (15.9)	3	1	1	0	1	1	0	0
Twin pregnancy	3 (6.8)	0	3	0	0	0	0	0	0
Parity > 3	1 (2.3)	0	0	0	1	0	0	0	0
GDM	1 (2.3)	0	1	0	0	0	0	0	0
Cardiac disease history^c	8 (18.2)	3	0	0	0	4	0	1	0
No risk factors	16 (36.4)	8	2	3	1	0	2	0	0

CVD: cardiovascular disease; CPA: cardiopulmonary arrest; GDM: gestational diabetes.

^aRespiratory symptoms; dyspnea, cough, palpitation.

^bChest, shoulder, back, abdominal, lamber pain.

^cCardiovascular disease-related history or diagnosis.

World Health Organization. The WHO application of ICD-10 to deaths during pregnancy, childbirth and puerperium: ICD-MM. Geneva: world Health Organization 2012. https://apps.who.int/iris/bitstream/handle/10665/70929/9789241548458_eng.pdf;jsessionid=760373AA8A881D03E12D07772DA4EF42?sequence=1

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