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 re lated to these deaths. Method. Maternal deaths are notifiable; when a maternal death occurs a mate rnal death notification form is filled in and sent to the provincial Matern al, Child and Women's Health (MCWH) units. Provincial assessors assess the death and submit a report. This report is forwarded to the National Committ ee on Confidential Enquiries into Maternal Deaths (NCCEMD), where the data are collated and the prevalence, pattern of disease, avoidable factors, mis sed opportunities and substandard care pertaining to maternal deaths are de scribed. Results. Data were collected on the maternal deaths occurring during 1998 i n 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 de ath were complications of hypertensive conditions in pregnancy, AIDS, obste tric haemorrhage, pregnancy-related sepsis and pre-existing medical conditi ons. Women aged 30 years and older were at greater risk of dying than young er women. Women in their first pregnancy or who had had 5 or more pregnanci es were also at greater risk. Obstetric haemorrhage was the most common cau se of death at level 1 hospitals, AIDS at level 2 hospitals and hypertensiv e diseases at level 3 hospitals. The vast majority of anaesthetic-related d eaths 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 mo re than half the cases of maternal death, the majority at the primary level of care. Poor initial assessment and diagnosis of cases, especially at sec ondary level of care, failure to follow standard protocols at primary and s econdary 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 mad e by the NCCEMD; if implemented these will result in a reduction of materna l deaths.