Maternal death and caesarean section in South Africa: Results from the 2011 - 2013 Saving Mothers Report of the National Committee for Confidential Enquiries into Maternal Deaths

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

Medical Science & Healthcare Practice ◽

10.22158/mshp.v1n1p42 ◽

2017 ◽

Vol 1 (1) ◽

pp. 42

Author(s):

Sam T Ntuli

Keyword(s):

South Africa ◽

Maternal Death ◽

Post Partum ◽

Tertiary Hospital ◽

Limpopo Province ◽

Hospital Death ◽

Maternal Deaths ◽

Obstetric Haemorrhage ◽

District Hospitals ◽

Post Partum Haemorrhage

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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The importance of cardiovascular pathology contributing to maternal death: Confidential Enquiry into Maternal Deaths in South Africa, 2011–2013

CardioVascular Journal of Africa ◽

10.5830/cvja-2016-008 ◽

2016 ◽

Vol 27 (2) ◽

pp. 60-65 ◽

Cited By ~ 23

Author(s):

P Soma-Pillay, ◽

J Seabe ◽

K Sliwa

Keyword(s):

South Africa ◽

Maternal Death ◽

Confidential Enquiry ◽

Maternal Deaths ◽

Cardiovascular Pathology

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Obstetric medical care and training in South Africa

Obstetric Medicine ◽

10.1177/1753495x18783610 ◽

2018 ◽

Vol 12 (1) ◽

pp. 27-30 ◽

Cited By ~ 3

Author(s):

Lizemarie Wium ◽

Valerie Vannevel ◽

Salome Bothma

Keyword(s):

South Africa ◽

South African ◽

Resource Poor Setting ◽

National Committee ◽

Confidential Enquiry ◽

Maternal Deaths ◽

Obstetrics And Gynaecology ◽

Obstetric Medicine ◽

Prevalence Of Obesity ◽

And Training

Obstetric medicine as a speciality is yet to be developed in South Africa. South Africa is regarded as a developing country. The burden of HIV and metabolic syndrome creates a need for advanced maternal care. An increase has been noted in hypertension and gestational diabetes due to increasing maternal age and increasing prevalence of obesity. The South African National Committee on Confidential Enquiry into Maternal Deaths’ 2015 Saving Mothers Report identified non-pregnancy-related infections as the leading cause of maternal deaths. Obstetric medicine care includes pre-conception, antepartum and postpartum care. This article aims to highlight the importance of obstetric medicine, even in a resource-poor setting. The current internal medicine and obstetrics and gynaecology training is discussed and emphasis is placed on the opportunity to create an obstetric medicine programme.

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The reliability of maternal audit instruments to assign cause of death in maternal deaths review process: a systematic review and meta-analysis

BMC Pregnancy and Childbirth ◽

10.1186/s12884-021-03840-3 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Ratnasari D. Cahyanti ◽

Widyawati Widyawati ◽

Mohammad Hakimi

Keyword(s):

Systematic Review ◽

Maternal Death ◽

Meta Analysis ◽

Diagnostic Reliability ◽

Maternal Deaths ◽

Measurement Tools ◽

Study Population ◽

Underlying Causes ◽

Meta Regression Analysis

Abstract Background Maternal Death Reviews (MDR) can assist in formulating prevention strategies to reduce maternal mortality. To support MDR, an adequate MDR instrument is required to accurately identify the underlying causes of maternal deaths. We conducted a systematic review and meta-analysis to determine the reliability of maternal death instruments for conducting the MDR process. Method Three databases: PubMed, ProQuest and EBSCO were systematically searched to identify related research articles published between January 2004 and July 2019. The review and meta-analysis involved identification of measurement tools to conduct MDR in all or part of maternal audit. Eligibiliy and quality of studies were evaluated using the Modified Quality Appraisal of Diagnostic Reliability (QAREL) Checklist: Reliability Studies. Results Overall, 242 articles were identified. Six articles examining the instrument used for MDR in 4 countries (4 articles on verbal autopsy (VA) and 2 articles on facility-based MDR) were included. None of studies identified reliability in evaluation instruments assessing maternal audit cycle as a comprehensive approach. The pooled kappa for the MDR instruments was 0.72 (95%CI:0.43–0.99; p < 0.001) with considerable heterogeneity (I2 = 96.19%; p < 0.001). Subgroup analysis of MDR instruments showed pooled kappa in VA of 0.89 (95%CI:0.52–1.25) and facility-based MDR of 0.48 (95%CI:0.15–0.82). Meta-regression analysis tended to show the high heterogeneity was likely associated with sample sizes, regions, and year of publications. Conclusions The MDR instruments appear feasible. Variation of the instruments suggest the need for judicious selection of MDR instruments by considering the study population and assessment during the target periods.

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The impact of HIV infection on maternal deaths in South Africa

South African Journal of Obstetrics and Gynaecology ◽

10.7196/sajog.581 ◽

2012 ◽

Vol 18 (3) ◽

Author(s):

J Moodley ◽

D Chweneyagae ◽

N Delis-Jarrosay ◽

Z Farina ◽

S Fawcus ◽

...

Keyword(s):

South Africa ◽

Hiv Infection ◽

Maternal Deaths ◽

The Impact

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Maternal mortality-a three-year retrospective study in a rural medical college of India

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20212947 ◽

2021 ◽

Vol 10 (8) ◽

pp. 3019

Author(s):

Jayasree Hansda ◽

Debobroto Roy ◽

Krishnapada Das ◽

Manojit Sarkar ◽

Rumpa Das ◽

...

Keyword(s):

Maternal Mortality ◽

Maternal Death ◽

Tertiary Care ◽

Maternal Mortality Ratio ◽

Tertiary Care Centre ◽

Maternal Deaths ◽

Demographic Profiles ◽

Medical College ◽

Mortality Ratio ◽

Tragic Event

Background: Maternal mortality is a tragic event as family revolves around a mother. The deadly obstetrical triad of hemorrhage, preeclampsia and infection has accounted for a third of all deaths. This study was conducted to assess maternal mortality ratio, demographic profile and causes of maternal death.Methods: This retrospective longitudinal study was conducted in the department of obstetrics and gynecology for a period of three years from 1st January 2018-31st December, 2020. Total no of death during this period was 134.Records of deaths and demographic profiles were retrieved from the medical record library of aforesaid hospital.Results: There were 134 maternal deaths amongst 56815 live births with MMR 235.85. The majority of deaths were in 20-29 year of age group and most of the deaths seen in multigravida. The 91.79% death was observed within the 24 hours and after 72 hours. Eclampsia, preeclampsia and hemorrhage were leading cause of maternal death seen in the study.Conclusions: Maternal mortality is higher than national MMR. Majority of maternal death were preventable by proper antenatal care, early detection of high-risk pregnancies and their timely referral to tertiary care centre.

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MATERNAL MORTALITY

The Professional Medical Journal ◽

10.29309/tpmj/2009.16.01.3002 ◽

2009 ◽

Vol 16 (01) ◽

pp. 135-138

Author(s):

TASNIM TAHIRA REHMAN ◽

MAHNAZ ROOHI

Keyword(s):

Maternal Mortality ◽

Maternal Death ◽

Maternal Mortality Ratio ◽

Emergency Obstetric Care ◽

Obstetric Care ◽

Care Level ◽

Maternal Deaths ◽

Mortality Ratio ◽

Study Setting ◽

Very High

Objective: To find out maternal mortality ratio (MMR) and to determine major causes of maternal death. S t u d y d e s i g n:A descriptive study. Setting: Department of Obstetric and Gynaecology, Allied Hospital, Faisalabad. S t u d y period: From 01.01.2008 to31.12.2008. Materials a n d m e t h o d s : All cases of maternal death during this study periods were included except accidental deaths. Results:There were 58 maternal deaths during this period. Total No. of live births were 5975. MMR was 58/5975 x 100,000 = 970/100,000 live births.The most common cause of maternal death was hemorrhage (34.5%) followed by hypertensive disorders/eclampsia (31%). Most of thepatients (75.86%) were referred from primary & secondary care level. C o n c l u s i o n : Maternal mortality is still very high in underdevelopedcountries including Pakistan. We must enhance emergency obstetric care (EOC) to achieve the goal of reduction in MMR.

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Patients’ Lived Experiences of the Care Provided Before and After Caesarean Sections in the City of Tshwane, Gauteng, South Africa

Africa Journal of Nursing and Midwifery ◽

10.25159/2520-5293/8177 ◽

2021 ◽

Vol 23 (2) ◽

Author(s):

Tendani Ramukumba ◽

Tshidi M. E. Masala-Chokwe ◽

Takalani Mudau

Keyword(s):

South Africa ◽

Caesarean Section ◽

Lived Experiences ◽

Caesarean Section Rate ◽

Elective Caesarean Section ◽

Multidisciplinary Teams ◽

District Hospitals ◽

Before And After ◽

The City ◽

Nurses And Midwives

A caesarean section is an incision of the abdomen and uterine walls to deliver the foetus. An emergency caesarean section may be performed if complications during pregnancy or labour arise. Various indications such as abnormal presentation, a previous caesarean section, and other related conditions may need an elective caesarean section. In South Africa, the national average caesarean section rate between 2015 and 2016 was 26.2 per cent, whereas the rate in district hospitals was 24.1 per cent. At a community hospital in the City of Tshwane, the caesarean section rate of 32 per cent in 2015 was recorded as high. The aim of this research was to explore and to describe patients’ lived experiences of the care provided before and after a caesarean section in the City of Tshwane, Gauteng, South Africa. To achieve the aim of the study, a qualitative, exploratory, descriptive study was conducted. The sampling method used was purposive, and the sample size was determined by data saturation. An interview schedule was used to collect the data. The study concluded that some women were satisfied with the care provided, whereas the majority were dissatisfied. The need for strategies to improve such care provided by nurses and midwives was highlighted. Multidisciplinary teams have to acknowledge gaps and develop effective strategies to motivate nurses and midwives in the workplace to provide quality care. Research should be conducted to design an effective nursing framework for caesarean section care.

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Critical cases of maternal mortality - a severe obstetrical complication, reflecting the quality of medical services provided

HEALTH OF WOMAN ◽

10.15574/hw.2017.125.27 ◽

2017 ◽

pp. 27-30

Author(s):

Yu.V. Dondyuk ◽

Keyword(s):

Maternal Death ◽

Maternal Morbidity ◽

Obstetric Care ◽

Near Miss ◽

Maternal Near Miss ◽

Maternal Deaths ◽

Republic Of Moldova ◽

Mortality Index ◽

The Republic

Maternal near miss and maternal death audit has become an esssential process in the context of obstetric care in both developed and developing countries. The objective: of the present study was to assess the quality of medical services provided within the multilevel regionalized Perinatal Health System in the Republic of Moldova, by identifying the inconsistencies with existing standards of medical care, in cases of severe obstetric complications and maternal deaths. Materials and methods. All cases of maternal near miss cases and maternal deaths recorded in the Secondary and Tertiary Perinatal Centers of the Republic of Moldova during the period 2009–2014 were analyzed retrospectively. To assess the quality of obstetric care, the following indices have been calculated: maternal near miss/ maternal deaths ratio; the mortality index for each obstetric condition/ complication. Results. During a period of 6 years, in 11 Secondary and Tertiary Perinatal Centers of the Republic of Moldova there were registered 154 651 births, 2881 cases of maternal near miss and 21 maternal deaths. The General Mortality index was 0.72%, and the Mortality Index by direct obstetric morbidity was 0.48%. 92.86% of maternal deaths through direct obstetric causes were avoidable, and the proportion of near miss cases with substandard care was 81.85%. The most frequent gaps (82.48%) were caused by human factors, such as insufficient team work, communication deficiency, lack of knowledge and clinical skills necessary to properly recognize and treat critical obstetric patients, delay and errors in diagnosis and treatment, non-compliance with clinical protocols. Conclusions. The excessively high proportion of avoidable factors highlighted in the study is alarming and implies the need for more extensive activities and the development of strategies focused on ensuring the presence of qualified medical workers in medical institutions, which will allow the provision of qualitative care and safety for patients in the Republic of Moldova, reducing maternal morbidity and mortality. Key words: severe maternal morbidity, maternal near miss, maternal death, maternal mortality.

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