A review of maternal deaths in South Africa during 1998

Objective. To document the prevalence and causes of maternal mortality and to identify avoidable factors, missed opportunities and substandard care related to these deaths. Method. Maternal deaths are notifiable; when a maternal death occurs a maternal death notification form is filled in and sent to the provincial Maternal, Child and Women's Health (MCWH) units. Provincial assessors assess the death and submit a report. This report is forwarded to the National Committee on Confidential Enquiries into Maternal Deaths (NCCEMD), where the data are collated and the prevalence, pattern of disease, avoidable factors, missed opportunities and substandard care pertaining to maternal deaths are described. Results. Data were collected on the maternal deaths occurring during 1998 in South Africa. Collection of data on maternal deaths was incomplete and a maternal mortality ratio could not be calculated. However, a clear pattern of disease and problems in patient care emerged. The 'big five causes of death were complications of hypertensive conditions in pregnancy, AIDS, obstetric haemorrhage, pregnancy-related sepsis and pre-existing medical conditions. Women aged 30 years and older were at greater risk of dying than younger women. Women in their first pregnancy or who had had 5 or more pregnancies were also at greater risk. Obstetric haemorrhage was the most common cause of death at level 1 hospitals, AIDS at level 2 hospitals and hypertensive diseases at level 3 hospitals. The vast majority of anaesthetic-related deaths occurred at level 1 hospitals. Non-attendance and delayed attendance at the health institutions were the most common patient-orientated problems. Poor transport facilities and lack of intensive care facilities were the major administrative problems. Problems in the care of women occurred in more than half the cases of maternal death, the majority at the primary level of care. Poor initial assessment and diagnosis of cases, especially at secondary level of care, failure to follow standard protocols at primary and secondary levels, and poor monitoring of patients at all levels of care were the common health worker-related problems. Conclusion. Ten key recommendations based on this information have been made by the NCCEMD; if implemented these will result in a reduction of maternal deaths.