AFJOG

ORIGINAL RESEARCH African Journal of Obstetrics and Gynaecology | Volume 3 | Issue 1 | 2025 | Increase in Embolism Related Maternal Deaths During the 2020-2022 Triennial Period in South Africa: A cause for concern review of clinical files of the women who died. The NCEMD process isoverseenby theNationalCommitteeonConfidential Enquiry into Maternal Deaths (NCCEMD) that is appointed by the Minister of Health every three years. Maternal deaths are initially discussed at the healthcare institution where they occurred and reported to the Provincial Maternal, Child, and Women's Health (MCWH) coordinator using a Maternal Death Notification Form (MDNF) along with a copy of the deceased’s medical record. Each maternal death is reviewed by a provincial assessor pair of midwife and doctor to determine the underlying causes and avoidable factors. The findings are entered by the MCWH coordinator into the Maternal Morbidity and Mortality Audit System (MaMMAS) database, which the NCCEMD uses to generate annual and triennial reports. The objective of the NCCEMD review process is to identify underlying causes patient and health system related avoidable factors contributing to maternal deaths and to formulate national recommendations. Details of the NCEMD process can be obtained from an article published by Moodley. 10 Permission to publish this study was granted by the National Department of Health. RESULTS There were 3,019,165 deliveries and 3,803 maternal deaths, of which 116 were attributed to embolism. Therefore, embolism related maternal deaths accounted for 3.1% of all maternal deaths. Among the 116 embolism-related maternal deaths, 102 (87.9%) were due to pulmonary embolism and the remaining 14 (12.1%, amniotic fluid embolism. Overall, embolism ranked as the eighth leading cause of maternal deaths during the period under investigation(Table 1). Table 1: Causes of maternal deaths during the 2020- 2022 triennium Primary obstetric problem (N=3655) N (%) 1.Non pregnancy related infections (NPRI) 1063 (29.1) 2.Obstetric Haemorrhage (OH) 599 (16.4) 3.Hypertensive disorders of pregnancy (HDP) 539 (14.7) 4.Medical and Surgical (M&S) 513 (14.0) 5.Pregnancy related sepsis (PRS) 187 (5.1%) 6. Unknown 179 (4.9) 7. Miscarriage 166 (4.5) 8. Embolism 116 (3.1) 9. Ectopic pregnancy 103 (2.8) 10. Anaesthetic complications 77 (2.1) 11. Acute collapse of unknown cause 72 (2.0) 12.Adverse drug reaction 26 (0.7) 13. Miscellaneous 15 (0.4) Maternal and pregnancy characteristics of the women who died are summarised in Table 2. Just over a third (41, 35.3%) of the women who died were in the age group 35- 39 years. Eight-one the women (69.8%) were between the age group 25 to 39 years and attended antenatal care (88, 75.9%). Less than half (46, 45.1%) were HIV non-infected and 43 (42.2%) delivered via caesarean section. Table 2. Maternal and pregnancy characteristics Parameter N (%) Maternal age Pulmonary embolism (N=102) 10-14 15-19 20-24 25-29 30-34 35-39 40-44 Outside 10-44 or unknown Amniotic fluid embolism (N=14) 10-14 15-19 10-24 25-34 35-39 40-44 Outside 10-44/unknown 0 (0) 3 (2.9) 12 (11.8) 21 (20.6) 29 (28.4) 29 (28.4) 6 (5.9) 2. (2.8) 0 (0) 5 (35.7) 0 (0) 2 (14.3) 5 (35.7) 1 (7.1) 0 (0) Parity Pulmonary embolism P0 P1 P2 P3 P4 P5 P6 Unknown Amniotic fluid embolism P0 P1 P2 P3 P4 P5 P6 Unknown 23 (22.5) 26 (25.5) 24 (23.5) 17 (16.7) 4 (3.9) 2 (2.0) 2 (2.0) 4 (3.9) 6 (42.9) 2 (14.3) 5 (37.5) 0 (0.0) 1 (7.1) 0 (0.0) 0 (0.0) 0 (0.0) HIV status Pulmonary embolism Positive Negative Unknown/declined Amniotic fluid embolism Positive Negative Unknown/declined 37 (36.3) 46 (45.1) 19 (18.6) 4 (28.6) 8 (57.1) 2 (14.3) Antenatal care Yes No Unknown 88 (75.9) 12 (10.3) 16 (13.8) Mode of delivery Pulmonary embolism Normal/ assisted Caesarean section Unknown/undelivered Amniotic fluid embolism Normal/ assisted Caesarean section Unknown/undelivered 28 (27.4) 43 (42.2) 31 (30.4) 3 (21.4) 8 (57.4) 3 (21.4) The incidence of maternal deaths related to embolism, as indicated by the iMMR, initially exhibited an upward trend during the years 2005 to 2016, followed by a slight decline between 2017 and 2019. Subsequently, there was a marginal increase from 2020 to 2022 which coincided with the Covid-19 pandemic (Figure 1). Figure 1: Trend in maternal deaths due to embolism 2005-2022 African Journal of Obstetrics and Gynaecology | Volume 3 | Issue 1 | 2025 | 15