Contribution of postpartum haemorrhage to maternal death after caesarean section at Chris Hani Baragwanath academic hospital, South Africa from 1997 to 2014

Abstract

Background and objectives Haemorrhage at and after caesarean section has increasingly become a significant cause of maternal mortality in South Africa. This study was done to determine the frequency and characteristics of maternal mortality from haemorrhage associated with caesarean section at Chris Hani Baragwanath Academic Hospital (CHBAH) from January 1997 to March 2014. Methods The maternal record charts, of women who died from haemorrhage at and after caesarean section, were analysed for demographic and clinical and factors from a database of all maternal deaths at CHBAH, spanning the period 1997 to 2014 with permission from the gatekeepers . Haemorrhage deaths associated with the caesarean section, but caused by underlying problems, for example, placental abnormalities and uterine rupture, were excluded as these conditions are independent risk factors for bleeding at caesarean section. Descriptive statistics (means with standard deviations and medians with interquartile ranges) were used to analyse the data. Results There were 15 maternal deaths from caesarean section-related haemorrhage. Eleven deaths had caesarean sections at CHBAH, giving a cause-specific case fatality rate of 10.7 per 100 000 caesarean sections. The mean age of the women was 35.6 years. Two women were primigravid. Eight women (53%) had previous caesarean sections, and four were in the second stage of labour. Frequent contributory causes for haemorrhage were uterine atony [the failure of the uterus to contract adequately after the third stage of labour] (80%), broad ligament injury (40%), coagulopathy (40%) and uterine injury (33%). Ten women received blood transfusions, and 11 had hysterectomies, three at the time of caesarean section and eight at relook laparotomies. Difficulty at caesarean section was noted in ten cases. Conclusion Haemorrhage from caesarean section, as a cause of death, is less common at CHBAH than in South Africa as a whole. Risk factors for mortality from caesarean section include advanced maternal age, previous caesarean section and second stage caesarean section. Surgical difficulties and atonic uterus are frequently encountered at caesarean section.