4. Electronic Theses and Dissertations (ETDs) - Faculties submissions

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    Maternal death at Leratong Regional Hospital: a six-year retrospective review, South Africa
    (University of the Witwatersrand, Johannesburg, 2021-11) Motau, Tumelo Ngaka; Chauke, Lawrence
    Background: The aim of the study was to systematically examine the main causes of maternal deaths and contributing factors at Leratong Regional Hospital in order to recommend strategies that can assist in reducing maternal mortality at this level of healthcare. Objectives: The objectives of the study were to: determine the institutional maternal mortality rate at Leratong Regional Hospital between 2012 to 2017, compare the trend (year on year) in the iMMR over the study period, describe the profile of women who died during the period under study, describe the clinical and surgical management of the women who died, and to determine the leading causes of maternal deaths, contributing factors and avoidable factors. Methods: A hospital based retrospective study based on patient clinical records at Leratong hospital. It included all the maternal deaths that occurred at Leratong Regional Hospital during the six-year study period (2012-2017). Results: There was a total of 78 maternal deaths with 32441 live births giving the MMR of 240 per 100 000 live births. However only 74 files could be analysed. The results showed that there was a rise in the maternal mortality rate over a six years period. The majority (70, 94.5%) of the women who died were African, aged between 20-35 years (56, 76%), multigravida (54,73%) with a parity of three or more (23, 31%). Obstetric haemorrhage was the leading cause of maternal death particularly postpartum haemorrhage (11.14%) followed by non-pregnancy related infections, sepsis and eclampsia. Conclusion: Maternal mortality has decreased according to recent confidential enquiry into maternal death in South Africa (2017-2019) However our study did not demonstrate a decline but rather an increase in the maternal mortality rate at Leratong. It showed that most of the maternal deaths were avoidable and the need for urgent interventions in terms of education, improving access to health care facilities, intensifying health care worker skills training and better transport systems between health care facilities is important.
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    Maternal deaths due to hypertensive disorders in pregnancy: a four year review in a tertiary hospital
    (2024) Khan, Z. L.
    Background Hypertensive disorders of pregnancy (HDP) are leading causes of maternal mortality worldwide. In South Africa (SA) they account for the second most important cause of maternal mortality. Despite its prevalence and devastating consequences, no progress has been made in reducing deaths due to HDP during the last decade. Objectives The aim of this research study is to describe maternal deaths due to complications arising from HDP, in a tertiary hospital, specifically looking at maternal characteristics, management, timing, causes and avoidable factors. Methods This is a retrospective cross-sectional study involving a review of patient records at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) between January 2015 and December 2018. Patient files were retrieved from records, captured onto an Excel Spreadsheet and analysed using basic statistics. Results Patients that died were young, booked early and attended antenatal care. Few patients had risk factors for HDP but aspirin prophylaxis was not given. Antihypertensive treatment as well as Magnesium Sulphate (MgSO4) was often not initiated appropriately. Eclampsia was the most common cause of death and 87% of patients died in the post-partum period. Conclusions Early, quality antenatal care, early detection of disease, referral to the appropriate level of care and adequate treatment as well as timely delivery is necessary to reduce maternal deaths due to HDP. Large scale studies are needed to identify specific quality of care issues at all levels of care in order to implement measures to improve the outcomes.
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    Perinatal outcome of all maternal deaths at Chris Hani Baragwanath Academic Hospital from January 2014 to June 2019
    (2024) Afolayan, Nomshado Sthembile
    Background: Maternal death is a tragic event. Out of the total number of maternal deaths, 99% occur in lowand middle-income countries. Perinatal outcome is related to maternal wellbeing. Maternal death has a negative impact on the fetal and neonatal outcome in the short and long term. Objectives: To determine the perinatal outcomes of pregnancies that end in a maternal death at CHBAH over a 5-year period, to describe the causes of maternal death and to determine the stillbirth rate and early neonatal death rate within this population. Methods A retrospective cross-sectional study of the maternal deaths in women with a viable pregnancy from January 2014 till June 2019 at CHBAH. All maternal deaths with gestation > 26 weeks or neonatal weight >500g were included in the study. Data was extracted from maternal and neonatal files. The following information was retrieved; demographics, booking status, antenatal care, pregnancy outcome, fetal and neonatal outcome. The data was analyzed using STATA. Approval from the University of Witwatersrand Human Research Ethics Committee (Protocol number: M1911143) and the CEO was obtained. Results: There was a total of 184 maternal deaths during the study period and 147 were included in this study. The iMMR was 135 deaths per 100 000 live births. Hypertension was the highest direct cause of death at 37% (27/74) followed by pregnancy related sepsis 27.4% (20/74) and then obstetric hemorrhage 20.6% (15/74). Non-pregnancy related infections (NPRI) made up 52.1% (38/73) of indirect causes, with HIV and HIV-related complications contributing 84.2% of the NPRI causes, followed by the medical and surgical disorders respectively. One hundred and thirty-seven neonates were delivered and 14 were undelivered at the time of maternal death. There were also two set of twins and one set of triplets. Ninety-one (61.9%) were born alive and 51 (34.6%) were stillbirths. Of the 91 live births 6 (6.5%) had an early neonatal death. Of the 51 stillbirths, 14 (27.5%) were from undelivered maternal deaths and 11 (21.1%) were from perimortem caesarian sections. The SBR was 347 per 1000 total maternal deaths and an ENND rate was 66 per 1000 live births. The PNMR was high at 388 per 1000 maternal deaths which is12 times higher than the general population. Conclusion: Maternal deaths are associated with very poor perinatal outcomes, resulting in unacceptably high stillbirth rate, early neonatal death rate and perinatal mortality rate. The health of the mother has a significant impact on the perinatal outcomes of the pregnant woman. Most of the causes of death were mostly women with comorbidities , we therefore postulate that prenatal care and stringent antenatal care may assist in optimizing women and thus reducing maternal deaths and ultimately the perinatal outcomes.