{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T01:29:27Z","timestamp":1760059767046,"version":"build-2065373602"},"reference-count":27,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2025,7,14]],"date-time":"2025-07-14T00:00:00Z","timestamp":1752451200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Direcci\u00f3n General de Investigaciones de la Universidad Santiago de Cali","award":["DGI-01-2025"],"award-info":[{"award-number":["DGI-01-2025"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Background and aim: The death of a woman while pregnant or within 42 days of delivery, regardless of the cause of death, or even up to one year after the end of the pregnancy, due to causes related to or aggravated by pregnancy remains a critical public health problem globally and in Colombia. While the country shows a general decreasing trend (preliminary Maternal Mortality Ratio 38.6\/100,000 live births in 2023), significant regional disparities persist. Understanding precise underlying causes, especially in high-complexity referral centers, is vital. This study describes the sociodemographic and anatomopathological characteristics associated with autopsy-verified maternal mortality cases at a Level-4 hospital in southwestern Colombia (2000\u20132023). Methodology: A descriptive observational retrospective study analyzed 42 maternal mortality cases verified by clinical autopsy (2000\u20132023) at the Pathology Department of Universidad del Valle, a Level-4 referral center in Cali, Colombia. Cases met the WHO definition. Data on sociodemographic, clinical, and pathological characteristics were retrospectively extracted from clinical records and autopsy reports. Results: The analysis of 42 autopsies (2000\u20132023) showed that 85.7% were early maternal deaths. Indirect causes predominated (57.1%, n = 24) over direct (42.9%, n = 18). Septic shock was the main indirect cause (65.2% of indirect), often from endemic infections. Hypovolemic shock due to PPH was the main direct cause (50% of direct). A high proportion were from subsidized\/uninsured schemes (65.7%) and had a migratory history (20%). Discussion and conclusions: This study highlights the value of autopsy in revealing maternal mortality etiologies, showing a predominance of indirect\/infectious causes and endemic diseases often missed clinically, despite PPH remaining the main direct cause. Findings reaffirm the strong link between maternal death and social\/economic inequity, access barriers, and regional\/migratory vulnerabilities. Effectively reducing maternal mortality necessitates rigorous clinical management, regionalized public health strategies addressing inequities, and integrating pathological data for targeted surveillance.<\/jats:p>","DOI":"10.3390\/ijerph22071105","type":"journal-article","created":{"date-parts":[[2025,7,14]],"date-time":"2025-07-14T07:54:23Z","timestamp":1752479663000},"page":"1105","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Maternal Death: Retrospective Autopsy Study in Southwestern Colombia, 2000\u20132023"],"prefix":"10.3390","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2520-5198","authenticated-orcid":false,"given":"Jhoan Sebastian","family":"Cruz-Barbosa","sequence":"first","affiliation":[{"name":"Grupo de Investigaci\u00f3n en Salud Integral (GISI), Departamento Facultad de Salud, Universidad Santiago de Cali, Cali 760035, Colombia"},{"name":"Departamento de Patolog\u00eda, Facultad de Salud, Universidad del Valle, Cali 760043, Colombia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6729-7599","authenticated-orcid":false,"given":"Andr\u00e9s Felipe","family":"Valencia-Cardona","sequence":"additional","affiliation":[{"name":"Grupo de Investigaci\u00f3n en Salud Integral (GISI), Departamento Facultad de Salud, Universidad Santiago de Cali, Cali 760035, Colombia"},{"name":"Departamento de Patolog\u00eda, Facultad de Salud, Universidad del Valle, Cali 760043, Colombia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Armando Daniel","family":"Cort\u00e9s-Buelvas","sequence":"additional","affiliation":[{"name":"Departamento de Patolog\u00eda, Facultad de Salud, Universidad del Valle, Cali 760043, Colombia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2674-8725","authenticated-orcid":false,"given":"Yamil","family":"Liscano","sequence":"additional","affiliation":[{"name":"Grupo de Investigaci\u00f3n en Salud Integral (GISI), Departamento Facultad de Salud, Universidad Santiago de Cali, Cali 760035, Colombia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,7,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Garc\u00eda-Tiz\u00f3n Larroca, S., Amor Valera, F., Ayuso Herrera, E., Cueto Hernandez, I., Cu\u00f1arro Lopez, Y., and De Leon-Luis, J. (2020). Human Development Index of the Maternal Country of Origin and Its Relationship with Maternal near Miss: A Systematic Review of the Literature. BMC Pregnancy Childbirth, 20.","DOI":"10.1186\/s12884-020-02901-3"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"713","DOI":"10.1016\/j.ogc.2022.07.001","article-title":"Maternal Mortality in Low and Middle-Income Countries","volume":"49","author":"Lawrence","year":"2022","journal-title":"Obstet. Gynecol. Clin. N. Am."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1515\/jpm-2022-0061","article-title":"Why Maternal Mortality in the World Remains Tragedy in Low-Income Countries and Shame for High-Income Ones: Will Sustainable Development Goals (SDG) Help?","volume":"51","author":"Kurjak","year":"2023","journal-title":"J. Perinat. Med."},{"key":"ref_4","first-page":"e2024006","article-title":"Maternal Health in Cities: Analysis of Institutional Maternal Mortality and Health System Bottlenecks in Kampala City Uganda, 2016\u20132021","volume":"8","author":"Birabwa","year":"2024","journal-title":"J. Glob. Health Rep."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e064960","DOI":"10.1136\/bmjopen-2022-064960","article-title":"Maternal Mortality in Colombia during the COVID-19 Pandemic: Time Series and Social Inequities","volume":"13","author":"Garfield","year":"2023","journal-title":"BMJ Open"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"205520762211290","DOI":"10.1177\/20552076221129077","article-title":"Effect of a Model Based on Education and Teleassistance for the Management of Obstetric Emergencies in 10 Rural Populations from Colombia","volume":"8","author":"Escobar","year":"2022","journal-title":"Digit. Health"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1186\/s13031-020-00273-1","article-title":"Health in Conflict and Post-Conflict Settings: Reproductive, Maternal and Child Health in Colombia","volume":"14","author":"Langer","year":"2020","journal-title":"Confl. Health"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Alipour, J., Payandeh, A., and Karimi, A. (2023). Prevalence of Maternal Mortality Causes Based on ICD-MM: A Systematic Review and Meta-Analysis. BMC Pregnancy Childbirth, 23.","DOI":"10.1186\/s12884-023-06142-y"},{"key":"ref_9","first-page":"35","article-title":"Maternal Death Review at a Tertiary Hospital in Ethiopia","volume":"31","author":"Shiferaw","year":"2021","journal-title":"Ethiop. J. Health Sci."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"489","DOI":"10.4314\/ahs.v22i2.57","article-title":"Why Mothers Die at a Busy Tertiary Urban Hospital in Kampala, Uganda: A Comprehensive Review of Maternal Deaths 2016-2018 and Implications for Quality Improvement to Reduce Deaths","volume":"22","author":"Namagembe","year":"2022","journal-title":"Afr. Health Sci."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"216","DOI":"10.1186\/s12978-021-01268-8","article-title":"Decomposing the Urban\u2013Rural Inequalities in the Utilisation of Maternal Health Care Services: Evidence from 27 Selected Countries in Sub-Saharan Africa","volume":"18","author":"Samuel","year":"2021","journal-title":"Reprod. Health"},{"key":"ref_12","unstructured":"\u00c1vila Mellizo, G.A., and Rubiano, H. (2025, May 03). Protocolo de Vigilancia en Salud P\u00fablica. Mortalidad Materna, Available online: https:\/\/www.ins.gov.co\/buscador-eventos\/Lineamientos\/Pro_mortalidad%20materna%202024.pdf."},{"key":"ref_13","unstructured":"Ru\u00edz, L.A.V., Sandoval-Mart\u00ednez, D.K., and Mantilla-Hern\u00e1ndez, J. (2019). C Estudio de las biopsias de muertes maternas en un hospital universitario de alta complejidad en Santander, Colombia. Rev. Cubana Obstet. Ginecol., 45, Available online: http:\/\/scielo.sld.cu\/scielo.php?script=sci_arttext&pid=S0138-600X2019000200005&lng=es."},{"key":"ref_14","unstructured":"(2025, May 03). ICD-10 Version: 2010. Available online: https:\/\/icd.who.int\/browse10\/2010\/en."},{"key":"ref_15","unstructured":"Mellizo, G.A.\u00c1. (2025, May 03). Informe de Mortalidad Materna, Colombia, 2022, Available online: https:\/\/www.ins.gov.co\/buscador-eventos\/Informesdeevento\/MORTALIDAD%20MATERNA%20INFORME%202022.pdf."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1346","DOI":"10.1007\/s10995-012-1149-x","article-title":"Maternal Healthcare in Migrants: A Systematic Review","volume":"17","author":"Almeida","year":"2013","journal-title":"Matern. Child Health J."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Rodr\u00edguez Hern\u00e1ndez, J.M., Ariza Ruiz, L.K., Castro Barbudo, D., Vivas S\u00e1nchez, P., Matallana G\u00f3mez, M.A., G\u00f3mez Hern\u00e1ndez, L.J., Romero Mendoza, L., and Chaparro Narv\u00e1ez, P.E. (2023). Analysis of Inequalities and Inequities in Maternal Mortality in Choc\u00f3, Colombia. Int. J. Environ. Res. Public Health, 20.","DOI":"10.3390\/ijerph20126095"},{"key":"ref_18","first-page":"425","article-title":"Caracterizaci\u00f3n de La Mortalidad Materna Temprana En Bogot\u00e1. Estudio de Vigilancia Epidemiol\u00f3gica de Casos Centinela","volume":"87","author":"Molano","year":"2019","journal-title":"Ginecol. Obstet. Mex."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"C\u00e1rdenas-Cardenas, L.M., Cotes-Cantillo, K., Chaparro-Narv\u00e1ez, P.E., Fern\u00e1ndez-Ni\u00f1o, J.A., Paternina-Caicedo, A., Casta\u00f1eda-Orjuela, C., and De La Hoz-Restrepo, F. (2015). Maternal Mortality in Colombia in 2011: A Two Level Ecological Study. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0118944"},{"key":"ref_20","first-page":"33","article-title":"Factores biosociales asociados a la mortalidad materna en el departamento de Choc\u00f3 2013\u20132019","volume":"28","year":"2022","journal-title":"Rev. M\u00e9dica Risaralda"},{"key":"ref_21","first-page":"247","article-title":"Caracterizaci\u00f3n de la Mortalidad Materna en Bol\u00edvar: Estudio de Tres A\u00f1os","volume":"4","year":"2013","journal-title":"Rev. Cienc. Biom\u00e9dicas"},{"key":"ref_22","first-page":"127","article-title":"Descripci\u00f3n de Los Factores Contribuyentes a Las Muertes Secundarias a Trastornos Hipertensivos Asociados al Embarazo En Antioquia, Colombia (2012\u20132020)","volume":"92","year":"2024","journal-title":"Ginecol. Obstet. Mex."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"699","DOI":"10.15446\/rsap.v20n6.68156","article-title":"Demoras en mortalidad materna en el departamento de Santander 2012 a 2015","volume":"20","year":"2018","journal-title":"Rev. Salud P\u00fablica"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"e323","DOI":"10.1016\/S2214-109X(14)70227-X","article-title":"Global Causes of Maternal Death: A WHO Systematic Analysis","volume":"2","author":"Say","year":"2014","journal-title":"Lancet Glob. Health"},{"key":"ref_25","unstructured":"Garc\u00eda Bedoya, A. (2025, May 03). Mortalidad Materna (Per\u00edodo Epidemiol\u00f3gico VI), Available online: https:\/\/www.ins.gov.co\/buscador-eventos\/Informesdeevento\/MORTALIDAD%20MATERNA%20PE%20VI%202024.pdf."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Joubert, D., Rossouw, S., Solomon, C., and Meyer, P. (2022). Discrepancies between Clinical Diagnoses and Autopsy Findings: A Comparative Study Conducted in South Africa. S. Afr. Med. J., 879\u2013882.","DOI":"10.7196\/SAMJ.2022.v112i11.15825"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"551","DOI":"10.1111\/j.1365-2559.2005.02243.x","article-title":"Discrepancies Between Clinical and Autopsy Diagnosis and the Value of Post Mortem Histology; A Meta-Analysis and Review","volume":"47","author":"Roulson","year":"2005","journal-title":"Histopathology"}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/22\/7\/1105\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:09:23Z","timestamp":1760033363000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/22\/7\/1105"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,14]]},"references-count":27,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2025,7]]}},"alternative-id":["ijerph22071105"],"URL":"https:\/\/doi.org\/10.3390\/ijerph22071105","relation":{},"ISSN":["1660-4601"],"issn-type":[{"type":"electronic","value":"1660-4601"}],"subject":[],"published":{"date-parts":[[2025,7,14]]}}}