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Subject: search.filters.subject.Maternal Mortality

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Now showing 1 - 5 of 5
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    Outcomes of pregnant patients with cardiac disease at Chris Hani Baragwanath Academic hospital
    (2018) Mugwede, Maidei
    Introduction: The incidence of cardiac disease in pregnancy ranges between 0.1 – 4.0%. It is the 5th leading cause of maternal deaths in South Africa. Management of pregnant cardiac patients involves pre-pregnancy counselling, with risk assessment and monitoring of the mother and fetus by a multidisciplinary team which includes an obstetrician, materno-fetal medicine subspecialist, cardiologist, neonatologist, geneticist and an anaesthetist. Objectives: To determine the maternal morbidity and mortality in cardiac patients presenting at Chris Hani Baragwanath Academic Hospital (CHBAH), as well as their neonatal outcomes and to obtain information about specific cardiac conditions in these patients, their obstetric management and the short-term effects of pregnancy on the underlying cardiac lesion. Methods: This was a prospective descriptive study where post-delivery cardiac patients were approached to enrol in the study from August 2013 to January 2014. Data was collected from the patients’ antenatal records and cardiology reports. Patients were also interviewed to determine more detailed information regarding previous pregnancy outcomes and cardiac complications which were not available in the antenatal records. Neonatal information was obtained by follow-up visits to the neonatal wards. Results: Acquired cardiac conditions accounted for 88.1% of the study patients (Rheumatic Heart Disease (RHD) 42.9% being the most common) while 11.9% were congenital. Most of the patients had a New York Heart Association (NYHA) class of I (85.4%) at antenatal booking. Of the participants in the study, 33.3% were human immunodeficiency virus (HIV) positive. Caesarean section accounted for 66.7% of v the deliveries while 33.3% were by normal vaginal delivery. There were 42.9% of women who experienced morbidities during their pregnancies with 27.5% suffering a decline in their NYHA class. Only eleven patients had a post-partum ECHO, in whom 82% showed a decline in the ejection fraction (EF). Intrauterine growth restriction (IUGR) complicated 44% of pregnancies. The perinatal mortality rate was 7%. There were no maternal deaths. Conclusion: Rheumatic heart disease is still the predominant underlying cardiac lesion. There is considerable maternal morbidity and perinatal morbidity and mortality in cardiac patients at CHBAH. The multidisciplinary team approach is improving the maternal and perinatal outcome in pregnant women with heart disease at CHBAH.
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    Morbidity in women with placenta abruption: a descriptive prospective study
    (2017) Nkomo, Bongiwe Pamella
    Placental abruption is one of the causes of obstetric haemorrhage that is associated with adverse maternal and neonatal outcomes. Knowledge of the risk factors and complications of placental abruption is important to reduce the maternal and perinatal morbidity and mortality associated with this condition. Objectives 1. To determine the frequency of abruptio placentae at Chris Hani Baragwanath Academic Hospital. 2. To assess maternal risk factors common in the patients admitted with placental abruption. 3. To determine the number of patients that had operative deliveries. 4. To assess maternal morbidity associated with placental abruption. 5. To assess perinatal outcomes of births in women with abruptio placentae. Methods This was a descriptive prospective study of morbidity in women with placental abruption. The study was carried out in the department of Obstetrics and Gynaecology at Chris Hani Baragwanath Hospital (CHBAH). Patients with placental abruption who gave informed consent to participate in the study were interviewed using a structured questionnaire. The study was conducted at Chris Hani Baragwanath Hospital. The study was carried out over a 6 month period and 60 subjects were recruited. All the women with the diagnoses of placental abruption and singleton pregnancies were included in the study. Results Of the 13734 delivered women 60 patients (0.4%) had placental abruption. Out of the 60 patients 53 (83%) were booked. The age group was between 18 – 42 years with the mean age of 28.2±6.8years. The mean gestational age on admission was 31.8±4.7. Forty six (71.6%) patients had parity of one and more. The risk factors that were identified in the study were previous history of placental abruption which occurred in 4 patients (6.7%),previous caesarean section in 7 (11.7%).The commonest medical disorder observed was hypertensive disease, pre-eclampsia was found in 24 patients(40%), gestational hypertension was found in 5 patients (8.3%) and chronic hypertension in 4(6.7%). The maternal complications that were identified were PPH in 15(44%) patients that had stillbirths compared to 1(3.8%) in the group that had live births, DIC was observed in 8 (23.5%),haemorrhagic shock occurred in 2 (5.9%) of the patients, acute kidney injury in 20(58.8%) in the group that had stillbirths compared to 3(11.5%) in the group that had live births, Couvelaire uterus in 9(26.4%) in the group that had still births, hysterectomy was performed in 2 (5.8%) and ICU admission was required for 5 (14.7%) of the patients. The neonatal out comes that were observed were stillbirths in 34 patients, birth asphyxia in 5(19.2%) and ICU admission was required in 11(42.3%). There were no maternal deaths. Conclusion In conclusion placental abruption is still a dangerous complication for both the mother and baby. In this study the patients that had stillbirths had worse outcomes compared to those that had live births. Therefore the conditions that are associated with this condition should be identified. Early recognition of this condition as well as proper referral of the patient can ensure better outcomes.
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    Maternal mortality due to sepsis after caesarean section at Chris Hani Baragwanath Hospital from 1997-2014
    (2017) Dlamini, Zandile Barbara
    Background Pregnancy related sepsis is one of the leading direct causes of preventable maternal morbidity and mortality. Evidence shows that caesarean section increases the risk of developing sepsis threefold compared to vaginal deliveries. Maternal death from sepsis after caesarean section can be prevented by proper monitoring of patients from the antenatal period, during labour and delivery and by early recognition and aggressive treatment of puerperal sepsis. This study was conducted to determine the frequency of maternal death from sepsis after caesarean section at Chris Hani Baragwanath Academic Hospital, and to identify associated factors including the role of HIV infection. Methods This was a retrospective descriptive study of maternal death due to sepsis after caesarean section at Chris Hani Baragwanath Academic Hospital from January 1997 to December 2014. Maternal death records of women who died of sepsis after caesarean section were obtained from the maternal death data base in the Department of Obstetrics and Gynaecology at the hospital. Results There were 108 299 caesarean sections performed during the study period, and 24 women died from sepsis after caesarean section from 1997 to 2014. These deaths made up 3.6% of the 661 maternal deaths at the hospital in this period. Three women presented as referrals, and 21 had their operations done at Chris Hani Baragwanath. The frequency of maternal death from sepsis after caesarean section at the hospital was 0.02% or 19.4/100 000 caesarean sections. The mean age of the women was 28.8 years, with three (12.5%) less than 20 years of age. Twenty women (83.3%) had emergency caesareans. The most common indication for caesarean section was Prolonged labour (50%). Sixteen (66.7%) women were HIV-infected. Twenty women (83.3%) required surgical intervention for puerperal sepsis after caesarean section. Conclusion On average, one to two women die each year at Chris Hani Baragwanath Academic Hospital from puerperal sepsis associated with caesarean section. This study showed that sepsis after caesarean section was more commonly observed with emergency than with elective procedures, and that prolonged labour was the most frequently associated obstetric indication. HIV infected women were more susceptible to death from sepsis after caesarean section, compared with HIV uninfected women. Obstetricians and midwives need to be skilled in the prevention, identification and treatment of life-threatening sepsis after caesarean section.
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    Reducing maternal morbidity and mortality from caesarean section-related haemorrhage in Southern Gauteng
    (2017) Maswime, Tumishang Mmamalatsi Salome
    Introduction The number of maternal deaths from bleeding during and after caesarean section (BDACS) has increased dramatically in South Africa in recent years. Four studies were conducted to gain insight on measures to reduce maternal deaths from BDACS. The aim was to identify clinical and health system factors associated with near-miss and maternal death from BDACS. Methods A systematic review was done on near-miss from postpartum haemorrhage, with a sub-analysis on BDACS. The field research, done in southern Gauteng, included: 1) a six-month prospective near-miss audit of women with BDACS in 13 hospitals; 2) a two-year retrospective maternal death audit in seven hospitals; and 3) a health systems audit in 15 hospitals. Results The systematic review on near-miss from PPH found two studies that described near-miss from BDACS, with a mortality index of 0-11%. In the near-miss and maternal death audits, the main risk factors for BDACS were pre-operative anaemia and previous caesarean section. Atonic uterus was the main cause of haemorrhage, with associated failure to use second line uterotonic drugs. Failure to diagnose and treat shock was the main reason why women died. Most maternal deaths from BDACS occurred in regional hospitals. The hospital systems audit identified shortages of second line uterotonic drugs and surgical skills availability as contributors to near-miss and maternal death from BDACS. Conclusion Although bleeding may be arrested through obstetric surgical techniques and easily available drugs, severe BDACS is a complex disease that requires a multi-disciplinary approach in a functional health system, especially regarding the detection and management of hypovolaemic shock. Measures to reduce maternal morbidity and mortality from BDACS include health system strengthening, with high care and critical care facilities, and improving the availability of drugs and surgical skills at district and regional hospitals
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    A review of maternal death records of HIV + women in Sedibeng District, Gauteng
    (2012) Sejake, Senate Betty
    Introduction: The maternal mortality ratio in Sedibeng District, Gauteng Province, from 2002 – 2004 was 220/100000. For the past decade HIV has been identified as a factor that has slowed the decline in maternal deaths in South Africa. The purpose of this study was to describe personal and service level factors contributing to maternal mortality of HIV positive women. It is hoped that the results of this study will be useful in developing interventions that will assist to curb the maternal mortality ratio. Methodology: Maternal death records were reviewed for the period 2004-2009. Data was collected on antenatal care, hospital care after admission and access to HIV services. The data were analysed using Stata 10. The results were compared with the national guidelines for the care of HIV positive pregnant women so as to identify discrepancies between the two. Results: One hundred and twenty five maternal death records were reviewed. Of these, 90% booked late for antenatal care i.e. beyond 20 weeks gestation. The majority (60.8%) of the women were HIV positive. Of the HIV positive women, 37.5% had CD 4 counts less than 200, which made them eligible for antiretroviral therapy. Of those that were eligible for antiretroviral therapy, 50.0% did not access the antiretrovirals due to late booking and loss to follow-up. Another main finding was that 36% died during the postnatal period. Conclusion: The antenatal bookings occurred after 12 weeks gestation which limited the time for starting patients on antiretroviral therapy. The high number of deaths during the postnatal period may indicate poor postnatal care and follow-up; as antiretroviral therapy could have been started during the postnatal period. Recommendations: Early antenatal booking and early HIV testing should be encouraged in communities. Antenatal services should be integrated so that HIV positive pregnant women are treated comprehensively and that the focus is not only on HIV, but also on other conditions such as TB, pneumonia, anaemia and hypertension. All pregnant HIV positive women must be done CD 4 counts; and all those found to be eligible for antiretroviral therapy should be given antiretrovirals timeously. Such women should be followed up and monitored closely. Postnatal check-up at 3 days should be strengthened for the mother-and-baby pair.