Maternal Malperfusion and Placental Necrosis in Sudden Maternal Death: A Forensic and Histopathological Case Analysis of Severe Preeclampsia

Abstract

Background: Sudden maternal death associated with hypertensive disorders of pregnancy can be difficult to interpret when clinical and autopsy documentation is incomplete. Objectives: To describe a sudden maternal death in a woman with clinical and placental findings suggestive of severe preeclampsia and to emphasize the diagnostic value and limitations of placental histopathology. Methods: A forensic case of a 29-year-old gravida 3 para 2 woman at 32 weeks of gestation who was found dead at home was reviewed using available clinical records, laboratory findings, toxicology, placental gross examination, and histopathology. Results: Two weeks before death, headache, blurred vision, epigastric pain, hypertension, and proteinuria were documented. Laboratory findings included proteinuria +3, hematuria +1, and serum creatinine 2.1 mg/dL. Toxicological screening was negative. The placenta showed pale, firm infarcted areas. Histopathology demonstrated focal villous necrosis, ghost villi, and fibrinoid necrosis of maternal spiral arteries, consistent with maternal vascular malperfusion. Complete maternal organ findings and full exclusion of other major causes of sudden maternal death were unavailable. Conclusions: The findings strongly support severe preeclampsia as the underlying maternal condition associated with death; however, the immediate mechanism of death remains undetermined. Placental histopathology is valuable when integrated with complete clinical and forensic evaluation.