Thousands of mothers die after childbirth, maternal report shows

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Almost 5 000 women died while pregnant or within 42 days of giving birth in SA between 2008 and 2010, up on previous years. This is according to the Saving Mothers report, which summarises findings on the confidential enquiries into maternal deaths in SA.

The “big 5” accounted for 86.5 percent of maternal deaths, with non-pregnancy related infections (NPRI), at 40.5 percent, by far the biggest factor.

Most of these NPRI conditions were diagnosed before birth (59.7 percent), but the majority of deaths occurred after the births (60.6 percent).

Pneumonias (tuberculosis, pneumocystis pneumonia and other pneumonias) contributed to two-thirds (67 percent) of the NPRI deaths, followed by meningitis (12.9 percent) and gastroenteritis (5.2 percent).

Researchers noted that complications from antiretroviral therapy, although fairly rare, increased significantly in 2010, over 2008 and 2009. Liver complications and Stevens-Johnson syndrome were the most common.

Respiratory failure (64 percent) and cerebral complications (17.9 percent) were the most common final-NPRI causes of maternal deaths.

HIV infection was the most common contributory condition, with 87.3 percent of the women being HIV infected, 5.2 percent HIV-negative, 0.7 percent declined testing, and the status was unknown in 6.8 percent.

In this group, 69 percent had Aids (defined as a CD4 immunity count below 200).

The report identified the delay in accessing medical help and poor, or no antenatal-care attendance, as further patient-related factors.

The most common administrative-avoidable factor was the lack of appropriately trained staff doctors and nurses (6.2 percent) and a lack of intensive-care unit facilities (3.7 percent).

Obstetric haemorrhage was the second most common cause of maternal death, accounting for 688 deaths or 14.1 percent of the total. This is considered to be an avoidable cause of death involving bleeding during and after a caesarean section procedure.

The latest figure compared with 491 deaths in the 2005-2007 period. The haemorrhage-related maternal mortality ratio was 24.9 deaths per 100 000 live births, which is an increase from 18.8 in 2005-2007 and 20.7 in 2002- 2004.

There were considerable provincial variation, with the greatest numbers of haemorrhagic deaths occurring in the Eastern Cape, Gauteng and Limpopo and the lowest in the Western Cape.

Complications of hypertension in pregnancy (14 percent), pregnancy-related sepsis (9.1 percent) and medical and surgical disorders were the other major contributors to the deaths.

The Saving Mothers committee summarised its recommendations by pinpointing the “5 Hs” that could have a major impact on the escalating maternal mortality rates – HIV/Aids, haemorrhage, hypertension, health worker training and health system strengthening.

The 5H interventions would include: addressing HIV/Aids through earlier testing, and access to antiretrovirals; preventing severe haemorrhage by making it a major alert requiring immediate attention; recognising hypertension as life-threatening; training all healthcare workers in maternity care; and ensuring 24-hour access to functioning emergency obstetric care. – Health eNews Service


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