AFJOG

ORIGINAL RESEARCH African Journal of Obstetrics and Gynaecology | Volume 3 | Issue 1 | 2025 | Maternal deaths from Obstetric Haemorrhage 2020-2022 Trends in numbers of OH maternal deaths and maternal mortality rates Maternal deaths from OH increased slightly in the 2020- 2022 triennium and accounted for 599 maternal deaths (16.4% of total maternal deaths) compared to 544 (15.7%) in 2017-2019. OH was the second most common cause of maternal death with an iMMR of 19.8 deaths per 100,000 live births compared to 19.1 in 2017-2019. Thus, the promising reduction in OH MMR seen in the last triennium was not sustained (Figure 1). Figure 1: iMMR for OH for 8 triennia 0 5 10 15 20 25 30 iMMR/100000 live births Figure one. iMMR for OH for 8 triennia 1999-2001 2002-2004 2005-2007 2008-2010 2011-2013 2014-2016 2017-2019 2020-2022 Table one shows that the increase in OH deaths was largely seen in 2020 (200 deaths) and 2021 (237 deaths) but not in 2022 (162 deaths). The high number of OH deaths in 2020 and 2021 reflect an indirect effect of the Covid-19 pandemic, which had its greatest impact in these two years; and adversely affected the functioning of the health system due to staff shortages, reallocation of duties, overburdened intensive care units, and emergency transport services. 6 Table 1: Annual OH maternal deaths and iMMR 2017- 2022 Obstetric haemorrhage n % iMMR 2017 184 15.0 20.1 2018 181 15.3 19.2 2019 179 17.1 18.1 2020 200 16.3 19.3 2021 237 15.7 23.3 2022 162 16.3 16.7 Provincial variation in OH deaths and iMMR; and trends. Figure 2 shows that there was considerable provincial variation with the triennial iMMR (MDs per 100,000 live births) due to OH being highest in Free State (iMMR 31.1), Mpumalanga (iMMR 28.6) and North-West (iMMR 28.3), and lowest in Kwa-Zulu Natal (iMMR 14.7) and Western Cape (iMMR 9.4). Figure 2. iMMR for obstetric haemorrhage for the 2020-2022 triennium 0.0 5.0 10.0 15.0 20.0 25.0 30.0 35.0 EC FS GP KZN LP MP NW NC WC iMMR/100,000 live births Province EC Eastern Cape; FS Free State; GP Gauteng; KZN Kwa- Zulu Natal; LP Limpopo; MP Mpumalanga; NW NorthWest; NC Northern Cape; WC Western Cape. Figure 3 shows provincial trends in iMMR per province over four triennia Figure 3: iMMR for OH per province and 4 triennia 0 5 10 15 20 25 30 35 40 EC FS GP KZN LP MP NW NC WC SA iMMR/ 100000 live births Province Figure 3. iMMR for OH per province and 4 triennia 2011-2013 2014-2016 2017-2019 2020-2022 EC Eastern Cape; FS Free State; GP Gauteng; KZN Kwa-Zulu Natal; LP Limpopo; MP Mpumalanga; NW NorthWest; NC Northern Cape; WC Western Cape. Demographic and obstetric factors in women who died from OH. The following variables were considered in OH deaths : maternal age over 35 years (36.1%), prolonged labour (14.7%), anaemia (22.8%), HIV positive (33.2%), induced labour (14%), previous caesarean delivery (CD, 33.9%), and CD in the index pregnancy (49.4%). Figure 4 shows that increasing age was associated with higher iMMR for OH. Figure 4: iMMR comparison for obstetric haemorrhage and total per age category -2020- 2022 triennium 0.0 50.0 100.0 150.0 200.0 250.0 300.0 350.0 400.0 10. - 14 15. - 19 20 - 24 25 - 29 30 - 34 35 - 39 40 - 44 Outside 10 - 44 range & Unk iMMR/100000 live births Obstetric haemorrhage Maternal death Figure 5 shows that when OH is subdivided into causal subcategories, teenagers under 15years had a higher iMMR from uterine atony. Figure 5. iMMR per OH subcategory-2020-2022 triennium 0.0 2.0 4.0 6.0 8.0 10.0 12.0 14.0 16.0 18.0 10. -14 15. -19 20 -24 25 -29 30 -34 35 -39 40 -44 Outside 10-44 range& Unk iMMR/100000 live births Age range - Abruption with hypertension - Abruption withouthypertension - Placentapraevia - OtherAPHnotspecified - Ruptured uteruswithpreviousCD - Ruptured uteruswithoutprevious CD - Uterineatonyafter vaginaldelivery - Vaginal traumaaftervaginal delivery - Cervical traumaaftervaginal delivery - Retained placentaafterNVD (morb adherent) - Retained placentaafterNVD (not adherent) - Inverteduterus after vaginal delivery - OtherPPHnotspecifiedafter vaginal delivery - BleedingduringCD (morbidly adherent placenta) African Journal of Obstetrics and Gynaecology | Volume 3 | Issue 1 | 2025 | 07