Clinicopathological and histopathological spectrum of hysterectomy specimens in autopsy

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.