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

Sam T Ntuli,Francis L.M Hyera,Mabina Mogale,Shan Naidoo

doi:10.4102/sajid.v32i2.57

Abstract

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.

Highlights

IntroductionStudies in low-and-middle income countries reported a higher institutional Maternal Mortality Ratio (iMMR) in the major tertiary referral hospitals where obstetrics complications are concentrated
Maternal mortality is defined as the death of any woman while pregnant or within 42 days after delivery, miscarriage or termination of pregnancy, from any cause, excluding incidental causes.[1,2] In South Africa (SA), the institutional Maternal Mortality Ratio decreased from 176.2/100 000 live births in 2008/2010 to 154.06/100 000 live births in 2011/2013.3 the burden of non-pregnancy-related infections, obstetric haemorrhage and pre-eclampsia or eclampsia remains unchanged.[3]Studies in low-and-middle income countries reported a higher iMMR in the major tertiary referral hospitals where obstetrics complications are concentrated
Forty-three per cent of deaths occurred within 24 hours of admission, 35% died in Intensive Care Unit (ICU) and 89% were referred from regional and district hospitals and community health centres

Summary

Introduction

Studies in low-and-middle income countries reported a higher iMMR in the major tertiary referral hospitals where obstetrics complications are concentrated. Pre-eclampsia or eclampsia and pregnancy-related sepsis are the major factors contributing to the higher iMMR among women in tertiary hospitals[4,5,6,7,8,9,10,11,12,13,14] and South Africa.[3] Most maternal deaths are preventable if patients are given prompt appropriate treatment at the periphery, and are timeously and swiftly referred to higher centres.[11,18,19]

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Discussion

Conclusion