Trends in maternal deaths from Obstetric Haemorrhage in South Africa 2008-2010

Abstract

The most recent report on Maternal deaths in South Africa for 2008-2010 shows that there has been a significant increase in the number of maternal deaths (32.4%) due to obstetric haemorrhage and the Institutional Haemorrhage Maternal Mortality Ratio has increased from 18.8/100000 live births in 2005-2007 to 24.9/100000 live births in 2008-2010. This article is an abridged version of the chapter on the 688 maternal deaths from obstetric haemorrhage mentioned in the above report. The chapter identifies priority provinces (Mpumulanga, Limpopo, Free State and North West) and priority problems (bleeding associated with caesarean section, abruptio placentae and ruptured uterus) for particular attention. Bleeding during and after caesarean section accounted for 26.2% of deaths due to obstetric haemorrhage, occurring most commonly in public hospitals particularly district and regional. Obstetric haemorrhage continues to be the most common avoidable cause of maternal death; 81% of the deaths having been assessed as avoidable. Resuscitation was sub-optimal in 22.3% of cases where it was attempted and the cases had sufficient information to assess. Vignettes are presented to illustrate the numerous administrative problems and examples of poor quality of care. Interventions at different levels of care and by different stakeholders are discussed.