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 identified in this study are similar to those reported in other studies. Individuals aged 35 and older, those with obesity, prolonged hospitalizations, elevated body mass index, and a personal or family history of thromboembolism, along with co-morbid conditions such as pre-eclampsia, multiple pregnancies, maternal infections (e.g., HIV), and caesarean section deliveries, have been associated with an increased risk of pulmonary and amniotic fluid embolism. 6-9,16 In all cases of maternal deaths related to embolism, issues related to patient care, administrative procedures, and resuscitation efforts were noted. The risk factors identified in this study have been corroborated by another research. Individuals aged 35 and above, those with obesity, prolonged hospitalizations, high body mass index, and a personal or family history of thromboembolism, as well as co-morbid conditions such as pre-eclampsia, multiple pregnancies, maternal infections (e.g., HIV), and caesarean section deliveries, have been found to be associated with an increased risk of pulmonary and amniotic fluid embolism. 6-9,16 Despite the high reported association between HIV and thromboembolism 17 , 46 (55.4%) out of the 83 women with known HIV status in this study were HIV non-infected. It is difficult to make conclusive comment whether the HIV increased the risk in our study cohort. Most of the women who died attended antenatal clinics, presenting an opportunity for risk assessment, patient education, ongoing monitoring, and appropriate thromboprophylaxis. The most common presenting symptom among women who died of pulmonary embolism was shortness of breath. Pulmonary embolism should be considered when pregnant and postpartum women present with shortness of breath, and thromboprophylaxis should be initiated until the diagnosis is excluded in cases with a high level of suspicion. Acute collapse was the most common presenting symptom in women who died of amniotic fluid embolism. These findings underscore the importance of training healthcare workers in maternal resuscitation. Avoidable factors related to patient care, health systems, and resuscitation were also identified, and these should be addressed to improve patient outcomes. LIMITATIONS The study is based on a secondary assessment of national maternal death data and available patient clinical files; therefore, it is limited by the quality of the data collected. CONCLUSION Maternal deaths from embolism increased during the 2020 to 2022 period compared to previous years. This trend underscores the need for nationwide risk assessment strategies, including risk-based thromboprophylaxis. RECOMMENDATIONS Based on the study's findings, the following recommendations are proposed: 1. All pregnant women should be assessed for venous thromboembolism (VTE) risk factors during their initial antenatal visit, at each antepartum hospital admission, prior to delivery, in the immediate postpartum period, and upon each discharge from the hospital. 2. Standardized risk assessment tools and management pathways tailored to each woman's risk profile should be developed and implemented nationally. Pulmonary embolism should be ruled out in women with acute shortness of breath, especially those with chest pain or acute collapse. 3. Appropriate thromboprophylaxis should be initiated when suspicion for PE is high, evenwithout deep vein thrombosis, until a definitive diagnosis is made. 4. Clinicians should receive regular training in maternal resuscitation, participate in routine drills, and be knowledgeable about the symptoms and management of pulmonary and amniotic fluid embolism during pregnancy. 5. All units managing pregnant women should review thromboembolic events regularly , including maternal deaths, to identify systemic issues and clinical gaps. ACKNOWLEDGEMENT I would like to express my gratitude to Botle Mamabolo for her assistance with the tables, current and former NCCEMD members , MCWH coordinators and provincial assessors, for their diligent work in assessing maternal deaths, compiling the SavingMothers'Reportsandmakingvaluablerecommendations. REFERENCES ¤ ¤ ¥ ¡¡ ¡ ¡¦ ¤ ¤ £ ¡¡ ¡ £¡ ¥¤ § ¥¤ ¥¤ ¡¡ ¡ ¡ ¡ ¡ ¤ ¡¡ ¡ ¡ £ £ _ ¨ © ¦ ª « £ ¡¡ ¡ ¡ ¦ ¨ § £ £ ¡¡ ¡ ¡ ¦ £ ¡¡ ¡ ¡¦ £ « ¡¡ ¡ ¡¦ ¬ « ¡¡ ¡ ¡¦ ¦ £ ¡¡ ¡ ¡ £ £ ¤ ¡¡ ¡ ¡¦ ¦ ¨ © £ ¡¡ ¡ ¡ ¦ African Journal of Obstetrics and Gynaecology | Volume 3 | Issue 1 | 2025 | 17