AFJOG

African Journal of Obstetrics and Gynaecology | Volume 3 | Issue 1 | 2025 | 27 ORIGINAL RESEARCH African Journal of Obstetrics and Gynaecology | Volume 3 | Issue 1 | 2025 | Maternal deaths due to acute collapse of unknown cause during the 2020-2022 triennium ABSTRACT Objective: To describe the profile, causes, and avoidable factors associated with maternal deaths due to acute collapse of unknown origin during the triennial period 2020 to 2022. Methods: Data on maternal deaths resulting from acute collapse of unknown cause for the triennial period 2020-2022 was extracted from the Maternal Morbidity and Mortality Audit System (MaMMAS) database and analysed using descriptive statistics(absolute numbers and frequencies). Permission to publish the study was granted to the National Committee on Confidential Enquiry into Maternal Deaths (NCCEMD) by the Department of Health. Results: There were 3,019,165 deliveries and 3,803 maternal deaths, 72 (1.9%) of which were due to acute collapse of unknown cause, making it the 11th most common cause of maternal mortality during this period. Half of the women (36, 50.0%) were in the age group 25 to 34 years. The majority of the women who died had a parity of zero to two (57, 79.2%) and were HIV non-infected (39,4.2%). Slightly just over a third (25, 34.7%) of the deaths occurred in district hospitals, followed by central and tertiary hospitals(19, 26.4%). Only 14 (43.8%) of the women who died delivered via caesarean sections. The highest incidence of institutional maternal mortality ratio (iMMR) was observed in the age groups 10-14 and 40-44 years. The final cause of death remained unknown in 26 cases (36.1%). Patient-related (24, 38.1%), administrative (26, 41.3%), and resuscitation-related avoidable factors (23, 63.5%) were found in 63 of the cases that were assessed. These factors need to be addressed in order to reduce maternal mortality due to acute collapse of unknown cause. Conclusion: While the trend shows a downward trajectory, maternal deaths due to acute collapse of unknown cause remain a public health concern, and the underlying cause in many of the cases remain unknown despite clinical assessments, investigations, and post-mortem examinations. The above underscore the importance of public awareness regarding associated risk factors and preventative strategies such as family planning, healthcare worker training in resuscitation skills, and quality assurance in performing post-mortem examinations. INTRODUCTION Maternal acute collapse is a rare, sudden, and life- threatening event that can occur at any stage during pregnancy and up to six weeks postpartum. 1 . It affects the cardiac, respiratory, and central nervous systems by disrupting blood and oxygen supply, leading to reduced organ perfusion and death if untreated. 1,2 Causes include complications of hypertensive disorders of pregnancy (e.g., eclampsia, intracranial haemorrhage), anaesthetic complications (e.g., high spinal), motor vehicle accidents, severe bleeding, cardiovascular complications (e.g., cardiac tamponade, myocardial infarction, arrhythmias), septic shock, drug-related factors (e.g., oxytocin and tranexamic acid drug administration errors, illicit drug use), embolism (amniotic and pulmonary), hypothermia, hypokalaemia/ hyperkalaemia, and toxins. 2-4 The most common causes of maternal acute collapse during pregnancy include embolism (amniotic fluid and pulmonary), medication administration errors, myocardial infarction, mechanical valve thrombosis, acute aortic dissection, cerebrovascular incidents, anaphylaxis, and complications related to anaesthesia (both local and regional). 4 Due to the sudden and unpredictable nature of this condition, timely recognition and effective maternal resuscitation are essential . Despite the significant impact of acute collapse on maternal deaths, data on these fatalities from Sub-Saharan Africa (SSA), including South Africa (SA), is scarce, particularly the profiles of the women who die, underlying causes, and avoidable factors. In this article, we present an analysis of maternal deaths due to acute collapse of unknown cause in South Africa during the 2020- 2022 triennium, with an emphasis on the profiles of the women who died, underlying causes, and avoidable factors. METHOD The process regulating the reporting and assessment of maternal deaths in South Africa is known as the Confidential Enquiry into Maternal Deaths (CEMD). 6 Each maternal death in healthcare facilities is first discussed internally and then reported to the Provincial Maternal, Child, and Women's Health (MCWH) coordinators using a Maternal Death Notification Form (MDNF) together with a copy of the deceased’s medical file. The internal discussion is part of the continuous quality improvement process. All deaths from each province are analysed by provincial assessors in terms of causes and avoidable factors and findings entered into the Maternal Morbidity and Mortality Audit System (MaMMAS) database by the Provincial MCWH coordinator. The National Committee on Confidential Enquiries into Maternal Deaths (NCCEMD) uses this database to generate annual and triennial reports. The main aim of the CEMD review is to identify the underlying causes as well as individual and health system related avoidable factors and use the information to formulate recommendations. Readers are referred to the article by Moodley 7 for detailed description of this process. L Chauke 1 ; S N Cebekhulu 2 1 .Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand and National Committee on Confidential Enquiry into Maternal Deaths (NCCEMD) 2 .Department of Obstetrics and Gynaecology, Dr George Mukhari Academic Hospital-Sefako Makgatho Health Science University, Gauteng Department of Health, Gauteng, South Africa and National Committee on Confidential Enquiries into Maternal Deaths-SA CORRESPONDENCE: L Chauke | Email: lawrence.chauke@wits.ac.za Maternal deaths due to acute collapse of unknown cause during the 2020-2022 triennium