Obstetrical Haemorrhagic Mortality in a Tertiary Hospital of the Limpopo Province, South Africa

Background: Obstetric haemorrhage is potentially fatal. Its frequency contributes to assessment of population health. So this study purpose was to assess the maternal deathsdue to obstetric haemorrhage in a tertiary hospital of the Limpopo Province, South Africa. Methods: Allmaternal deaths, which occurred at Pietersburg Hospitalfrom January 2011 to December 2015 were reviewed. The hospital death register was used to collate the list of maternal deaths.Maternalage, parity, referring facility, date of admission and death, ward where death occurred, and causes of deathwere collected from delivery registers and patient medical records.Results: There were 232 maternal deaths of which 48 (20.7%) were due to obstetrical haemorrhage. The mean age of the 48 women was 31.7±6.7 year range 15-48 years. Thirty one of 48 haemorrhagic deaths (65%) occurred within 24 hours of admission, 16 of 48 (33%) had a parity of 3 or more, 19 (40%) died in ICU and 12 (25%) in casualty. Forty three of 48 women (90%) were referred, of which 36 (84%) were from district hospitals. Post-partum haemorrhage accounted for 39 of 48 (81%) deaths followed by unspecifiedante-partum haemorrhage accounting for 4 (8%) and placenta abruption 2 of 48 (4%).Conclusion: This study demonstrated that a maternal death due to obstetric haemorrhage remains a major concern in Limpopo Province. Post-partum haemorrhage was the main cause of deaths.

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An investigation of maternal mortality at a tertiary hospital of the Limpopo province of South Africa

Southern African Journal of Infectious Diseases ◽

10.4102/sajid.v32i2.57 ◽

2017 ◽

Vol 32 (2) ◽

pp. 73-76

Author(s):

Sam T. Ntuli ◽

Mabina Mogale ◽

Francis L.M. Hyera ◽

Shan Naidoo

Keyword(s):

Maternal Mortality ◽

Maternal Mortality Ratio ◽

Tertiary Hospital ◽

Limpopo Province ◽

Hospital Death ◽

Maternal Deaths ◽

Live Births ◽

Obstetric Haemorrhage ◽

District Hospitals ◽

Mortality Ratio

Objective: To understand the elements influencing the maternal deaths in the Limpopo province, South Africa.Methods: A retrospective review of all maternal deaths which occurred at the Pietersburg Hospital, Limpopo province was done over a five-year period (January 2011 to December 2015). The hospital death register was used to collate a list of maternal deaths occurring during the study period. The medical records of maternal deaths were reviewed. The total deliveries and live births for each year were obtained from the delivery registers. The data collected included maternal age, parity, referring facility, date of admission, date and time of death, ward where death occurred, and cause of death.Results: There were 14 685 live births and 232 maternal deaths between 2011 and 2015, resulting in an institutional Maternal Mortality Ratio (iMMR) of 1579/100 000 live births. The mean age of the patients was 29 years. Forty-three per cent of deaths occurred within 24 hours of admission, 35% died in ICU and 89% were referred from regional and district hospitals and community health centres. Of the referred patients, 83% were from district hospitals. Obstetric haemorrhage and pre-eclampsia, or eclampsia, were the main causes of death.Conclusion: The iMMR at Pietersburg Hospital remains unacceptably high. Most of the maternal deaths are due to obstetric haemorrhage, pre-eclampsia or eclampsia, medical and surgical disorder and non-pregnancy related infections.

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Comparison of Causes of Maternal Mortality in the Limpopo Province between 2011/13 and 2014/16: Findings from the National Committee of Confidential Enquiry into Maternal Deaths in South Africa

10.21203/rs.2.13378/v1 ◽

2019 ◽

Author(s):

Sam Ntuli ◽

Maboya EM ◽

FLM Hyera ◽

S Naidoo

Keyword(s):

South Africa ◽

Pulmonary Embolism ◽

Maternal Death ◽

Statistical Significance ◽

Limpopo Province ◽

National Committee ◽

Confidential Enquiry ◽

Maternal Deaths ◽

Hypertensive Disorders ◽

Obstetric Haemorrhage

Abstract Objective To review and compare underlying causes of maternal deaths in Limpopo Province (LP) using data of the National Committee of Confidential Enquiry into Maternal Deaths in South Africa (NCCEMD). Method This is a review of the findings of the causes of maternal deaths from the two trienniums 2011-2013 and 2014-2016 of the NCCEMD. When pregnancy related deaths occur a maternal death notification form is completed and submitted to the provincial Maternal, Child and Women's Health (MCWH) units. The provincial assessors assess the death and forward the report to the NCCEMD, where the data are collated and analyzed to provide summary estimates for the extent of important public-health problems. Results In the triennial 2011/13, 750 women deaths were recorded in LP of which 728 (97.1%) were maternal deaths and 22(2.9%) were coincidental deaths. While in the triennial 2014/16, of the 623 women deaths, 607(97.4%) were maternal deaths and 16 (2.6%) were coincidental deaths. In both trienniums, non-pregnancy related infections, obstetric haemorrhage, pregnancy-induced hypertensive disorders and medical and surgical disorders were the leading cause of deaths and accounted for two-thirds of maternal deaths. The number of deaths due to non-pregnancy related infections significantly decreases from 228 to 135 (p<0.05), while deaths due to medical and surgical disorders slightly increased (from 66 to 69, p>0.05). There was a marked reduction in the number of obstetric haemorrhage, pregnancy-induced hypertensive disorders, pregnancy-related sepsis, anaesthetic complications, ruptured ectopic pregnancy and acute collapse-cause unknown but the result did not reach statistical significance (p>0.05), and deaths due to miscarriage increased (p>0.05). The number of deaths due to pulmonary embolism increased significantly (p<0.05). Conclusion Although there is a reduction in the number of maternal deaths in LP, non-pregnancy related infections, obstetric haemorrhage, pregnancy-induced hypertensive disorders and medical and surgical disorders remain the major causes of maternal death and pulmonary embolism is an emerging concern.

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Active management of third stage of labour, post–partum haemorrhage and maternal death rate in the Vanga Health Zone, Province of Bandundu, Democratic Republic of the Congo

African Journal of Primary Health Care & Family Medicine ◽

10.4102/phcfm.v2i1.76 ◽

2010 ◽

Vol 2 (1) ◽

Cited By ~ 1

Author(s):

Jean-Pierre Fina Lubaki ◽

Jean-Robert Musiti Ngolo ◽

Lucie Zikudieka Maniati

Keyword(s):

Maternal Death ◽

Democratic Republic ◽

Post Partum ◽

Active Management ◽

Maternal Deaths ◽

Third Stage ◽

Post Test ◽

Republic Of The Congo ◽

Health Zone ◽

Post Partum Haemorrhage

Background: Post-partum haemorrhage (PPH) is the single largest cause of maternal death worldwide and a particular burden for developing countries. In Africa, about 33.9 % of maternal deaths are due to PPH. In the Democratic Republic of the Congo (DRC), the prevalence of PPH is unknown. PPH can be prevented with active management of the third stage of labour (AMTSL). Objectives: To describe the practice of AMTSL in Vanga Health Zone and to calculate the incidence of PPH in Vanga Health Zone.Method: An intervention study with post-test-only design was conducted among health maternity wards using a data collection sheet to obtain information. All pregnant women attending Vanga Health maternity wards constituted the study population. Frequencies were determined for variables of interest.Results: From April 2007 to March 2008, 6339 deliveries took place at Vanga Health maternity wards, representing 71% of the institutional delivery rate. The number of deliveries realised with the practice of (AMTSL) were 5562; 366 cases of PPH were reported, making an incidence of 5.77%. Three cases of maternal deaths – two of which were related to PPH – were reported during the study period, which means there was a decline of 70% compared with the previous two years.Conclusion: The prevalence of PPH has been estimated to be 5.77%; PPH represents the cause of 67% of all maternal deaths. The extension of AMTSL practice, combined with the assurance of better supplies of oxytocin to enhance drug management, is strongly advised/suggested. As a number of births still take place outside the health maternity wards, the introduction of oral misoprostol could be considered a part of AMTSL for use by patients being treated by traditional midwives.

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An analysis of the direct cost of renal dialysis provided through a public-private partnership at a tertiary hospital in Limpopo Province, South Africa

South African Medical Journal ◽

10.7196/samj.2019.v109i8.13597 ◽

2019 ◽

Vol 109 (8) ◽

pp. 577

Author(s):

T A Malatji ◽

J Wamukuo ◽

F L M Hyera

Keyword(s):

South Africa ◽

Direct Cost ◽

Renal Dialysis ◽

Tertiary Hospital ◽

Public Private Partnership ◽

Limpopo Province ◽

Private Partnership

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Can we reduce post-partum haemorrhage maternal deaths?

African Journal of Midwifery and Women s Health ◽

10.12968/ajmw.2013.7.1.5 ◽

2013 ◽

Vol 7 (1) ◽

pp. 5-5

Author(s):

Christina Mudokwenyu-Rawdon

Keyword(s):

Post Partum ◽

Maternal Deaths ◽

Post Partum Haemorrhage

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Use of Recombinant Activated Factor VII in Severe Post-Partum Haemorrhage: Data From the Italian Registry. A Multicentric Observational Retrospective Study.

Blood ◽

10.1182/blood.v114.22.4434.4434 ◽

2009 ◽

Vol 114 (22) ◽

pp. 4434-4434

Author(s):

Giovanni Barillari ◽

Maria Grazia Frigo ◽

Maddalena Casarotto ◽

Antonio Farnia ◽

Barbara Massè ◽

...

Keyword(s):

Post Partum ◽

Factor Vii ◽

Recombinant Activated Factor Vii ◽

Maternal Deaths ◽

Activated Factor Vii ◽

Rfviia Administration ◽

Perioperative Bleeding ◽

Before And After ◽

Life Threatening ◽

Post Partum Haemorrhage

Abstract Abstract 4434 Introduction Major Post-Partum Haemorrhage (PPH) is a life-threatening labour complication, which mainly occurs without warning, predictive signs or symptoms and often in absence of predisposing conditions. Severe PPH is defined by an estimated blood loss during the first 24 hours post-partum, of more than 500mL in case of natural delivery and of more than 1000mL in case of caesarean section. In developed countries PPH incidence is reported between 0.5% and 2%. In these countries it is the third cause of maternal mortality, after venous thromboembolism (VTE) and hypertension. In developing countries, major PPH is cause of 120-000-150.000 maternal deaths every year. Therapeutic strategies for severe PPH management are largely standardized. Recombinant activated factor VII (rFVIIa) is an activated factor VII form, produced from factor VII cDNA transfected into hamster kidneys. The first case of rFVIIa administration during perioperative bleeding has been reported in 1999, since this time rFVIIa has been used as adjunctive therapy in the management of patients with life-threatening and critical haemorrhages caused by trauma, abdominal or cardiac surgery or urological surgery, liver transplantation, post partum and any other bleeding condition leading to impairment of haemostasis Purpose To report the Italian real experience in clinical practice, in order to provide wide and detailed clinical information about use of rFVIIa in the management of massive primary PPH in our country and in order to evaluate the role of haemostatic therapy in the management of this severe life- threatening obstetric complication, so contributing to treatment protocols development. Methods An Italian retrospective survey of severe primary PPH cases treated with rFVIIa was performed. Anamnestic, clinical and haemostatic data about fourty-three patients with PPH, from 2005 to 2007, were collected. Coagulative parameters and transfusion requirements before and after rFVIIa treatment were compared. Results After rFVIIa administration INR was significantly decreased, while fibrinogen levels were markedly increased. Median of packed red blood cells units, platelets units, fresh frozen plasma, crystalloids and colloids needed, before and after rFVIIa administration, were significantly decreased (tab.1). Thirty-four of 43 patients needed surgical intervention before rFVIIa administration, 11/43 after treatment. Hysterectomies have been performed respectively in 12/43 cases before and in 7/43 cases after rFVIIa infusion. The response to rFVIIa is shown in table 2 No maternal deaths have been reported. No adverse events or thromboembolic complications were observed. Conclusion rFVIIa administration represents a safe haemostatic approach in the management of severe PPH cases, when other conventional medical, surgical and radiology interventional approaches have not been successful. Data from Italian Registry, as well as from other case series, demonstrate the rFVIIa efficacy to reduce or stop obstetric critical bleeding. The use of rFVIIa as lifesaving therapy in cases, in which medical and surgical standard approach have failed, should be always considered as life well as uterus lifesaving treatment. Disclosures: Off Label Use: Safety and efficacy of rFVIIa in postpartum hemorrhage.

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Puerperas’ knowledge regarding postpartum exercises in a tertiary hospital in the Capricorn District of Limpopo Province, South Africa

South African Journal of Obstetrics and Gynaecology ◽

10.7196/sajog.2017.v23i1.1059 ◽

2017 ◽

Vol 23 (1) ◽

pp. 3

Author(s):

M O Mbombi ◽

M K Thopola ◽

J C Kgole

Keyword(s):

South Africa ◽

Tertiary Hospital ◽

Limpopo Province

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Systems approach for assessment of maternal deaths in Rajasthan: A feasibility study

European Journal of Public Health ◽

10.1093/eurpub/ckaa166.906 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

P Raghav ◽

M K Gupta ◽

N Rustagi ◽

N Mishra ◽

S Garg

Keyword(s):

Maternal Mortality ◽

Maternal Death ◽

Systems Approach ◽

Post Partum ◽

Maternal Mortality Ratio ◽

State Level ◽

The State ◽

Care Staff ◽

Health Care Staff ◽

Maternal Deaths

Abstract Background High maternal mortality in the state like Rajasthan, which is at second rank in terms of high Maternal Mortality Ratio (MMR) in India, require concentrated efforts in this direction The objectives of this study were to assess the magnitude and trend of maternal death and underlying factors contributing to maternal deaths in Rajasthan and to identify barriers and challenges in reporting maternal deaths in Rajasthan. Methods Data related to maternal deaths, cause of deaths and live births were retrieved from official Government sources and MMR was calculated. To find out the underlying factors contributing to maternal deaths, Verbal Autopsies were conducted through household surveys. In-depth interviews of health care staff were conducted to carry out the 'SWOT' analysis in order to identify the barriers in reporting maternal deaths. Data was analysed using SPSS version 23. Results A total of 7185 maternal deaths were reported from Rajasthan in last five years. The mean age of mothers was 25.18±4.98 years. Haemorrhage were reported as most common cause of maternal death (17%) followed by Severe hypertension or fits (8%) and obstructed labour (2%). The median duration of hospital stay was 23 hours (IQR=7.5-70). Maximum deaths were reported during post-partum period (61%), while around one fourth of the deaths happened during delivery. Conclusions The discrepancies were observed in the reporting of number and causes of maternal deaths. The trend and forecasted figures were quite different from the published National and State level reports in this regard. Key messages need to streamline and strengthen the Maternal Deaths Surveillance and Response to track the number of deaths and get the exact information about the underlying factors contributing to them. Effective strategies can be developed to reduce the Maternal Deaths in the State.

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