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Maternal deaths and deaths after unsafe abortion

  • Topic

The autopsy of a woman who dies in pregnancy, childbirth or the puerperium looks for the exact cause to prevent other deaths, not for someone to blame.

Updated

What it is

A maternal death is the death of a woman during pregnancy or within 42 days of its end, from any cause related to or aggravated by the pregnancy, but not from accidental or incidental causes; a late maternal death occurs after 42 days and before one year. Direct deaths result from obstetric complications (haemorrhage, hypertensive disorders, infection, amniotic fluid embolism, complications of abortion) and indirect deaths from diseases that existed before or that pregnancy aggravates. In Colombia every maternal death is notified immediately to the surveillance system and reviewed by an analysis unit. The autopsy is clinical when the underlying cause is unknown, and medico-legal when there are injuries, violence, or a suspected medical act or non-spontaneous abortion. In Colombia, voluntary termination of pregnancy is legal up to week 24 and, after that, on the three grounds set by the Constitutional Court (see Medical ethics); the WHO regards unsafe abortion as a preventable cause of maternal death. The autopsy describes findings: it does not judge the woman.

Key facts

  • Haemorrhage: estimate the blood in the body cavities and examine the uterus, placenta (accreta), tears and uterine rupture.
  • Amniotic fluid embolism: look on histology for fetal squames and mucin in the pulmonary vessels.
  • Pre-eclampsia and eclampsia: haemorrhage and periportal necrosis in the liver, kidney injury and cerebral haemorrhage.
  • Infection after abortion or delivery: examine the uterus, adnexa and peritoneum, with cultures and histology.
  • Pulmonary embolism and peripartum cardiomyopathy: examine the deep veins of the legs and pelvis and the heart with histology.
  • In Colombia, an autopsy series of maternal deaths at a referral hospital found mostly indirect causes, above all septic shock, and among direct causes, postpartum haemorrhage.

Next step: what to do and document

  • When a pregnant or postpartum woman dies, notify Sivigila at once and keep the complete medical record for the analysis unit.
  • If the underlying cause is unclear, request a clinical autopsy; if there are injuries or suspected violence, medical act or non-spontaneous abortion, inform the Fiscalía for a medico-legal autopsy.
  • Record gestational age, the timing of care, drugs, blood products and procedures, with the time.
  • Write in descriptive, non-judgemental language: the aim is the cause of death, not the woman's conduct, and the information is confidential.
  • Tick the pregnancy box on the death certificate; if it is left out, the maternal death stays hidden.
  • Decree 786 of 1990, art. 7(f): autopsies of pregnant women or of the product of conception are singled out when a non-spontaneous abortion is suspected; (e): when the death is suspected to have been caused by a medical act.
  • Public health surveillance protocol for maternal mortality of the Instituto Nacional de Salud (version 09, 2024): immediate individual notification (event 550), an analysis unit within 45 days of notification and a clinical autopsy when the underlying cause is unknown.
  • The legal grounds and time limits for voluntary termination of pregnancy are covered in Medical ethics.
  • Official text checked on 2026-11-13 at funcionpublica.gov.co and ins.gov.co.

Test yourself

Think of the answer, then tap the question to see it.

How is maternal death defined?

The death of a woman during pregnancy or within 42 days of its end, from a cause related to or aggravated by the pregnancy, not accidental or incidental.

Which histological finding supports amniotic fluid embolism at autopsy?

Fetal squames, mucin or other amniotic fluid elements in the pulmonary vessels.

Is the death of a pregnant woman in a road traffic crash a maternal death?

No; it is a coincidental death. It still needs a medico-legal autopsy because it is a violent death.

What are the typical fatal complications of unsafe abortion?

Haemorrhage, infection and perforation of the uterus or injury to other organs from inserted objects.

What deadline does the INS protocol set for the analysis unit of an early maternal death?

Within 45 days of the case being notified.

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Educational content on forensic and legal medicine; not legal advice and no substitute for the technical guides of Colombia's National Institute of Legal Medicine and Forensic Sciences. Laws change: each page links the official text and says when it was last checked. For a real case, follow the guide in force and ask the competent authority.

Sources: Maternal mortality (fact sheet) (World Health Organization, 2025); Abortion (fact sheet) (World Health Organization, 2025); Protocolo de vigilancia en salud pública: mortalidad materna (versión 09) (Instituto Nacional de Salud (INS), 2024); Maternal Death: Retrospective Autopsy Study in Southwestern Colombia, 2000-2023 (International Journal of Environmental Research and Public Health (PMC), 2025); Decreto 786 de 1990: autopsias clínicas y médico-legales y viscerotomías (compilado en el Decreto 780 de 2016) (Función Pública, Gestor Normativo, 1990).

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