AFJOG

African Journal of Obstetrics and Gynaecology | Volume 3 | Issue 1 | 2025 | 28 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 The CEMD assessment process uses the WHO ICD-10 adaptation to classify maternal deaths by primary obstetric causes such as non-pregnancy-related infection (NPRI), hypertensive disorders of pregnancy (HDP), obstetric haemorrhage (OH), and pregnancy-related sepsis (PRS). NPRI is further divided into COVID-19 pneumonia, bacterial pneumonia, and tuberculosis, and OH into bleeding at caesarean section or from an atonic uterus. Data on maternal deaths from acute collapse of unknown cause during the triennial period 2020-2022 was extracted from the MaMMAS database and analysed using descriptive statistics (absolute numbers and frequencies). Permission to publish the study was granted to the NCCEMD by the National Department of Health (NDOH). RESULTS There were 3,019165 deliveries, 3803 maternal deaths and 72 (1.9%) of the maternal deaths were due to acute collapse of unknown cause making acute collapse the 11th most common cause of maternal deaths during the 2020-2022 triennial period (Table 1). Table 1: Causes of maternal deaths during the 2020- 2022 triennium Primary obstetric problem Maternal deaths (N=3655) 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%) Half of the women who died (36) were in the age group 25-34 years, followed by 35-39 years (13, 18.1%) . The majority of the women (57, 79.2%) had a parity of zero to two. Just over half (39, 54.2%) were HIV non-infected. Nineteen (86.4%) out of the 22 women who were HIV infected were on antiretroviral (ARV) treatment. Twenty- five deaths occurred in district hospitals (25, 34.7%) and 19 (26.4%) in central and tertiary hospitals combined. The least number of maternal deaths occurred in regional hospitals, 13(18.1%). Thirty-two women (44.4%) delivered via caesarean section before they died, and 14 (43.8%) of the caesarean sections were performed at central and tertiary hospitals. In terms of provinces, the highest number of maternal deaths due to acute collapse of unknown cause 27 (37.5%) were reported in Gauteng Province, 13 (18.1%) in KwaZulu-Natal and 10 (13.9%) in the Western Cape (10, 13.9%) (Table 2). Table 2. Maternal characteristics Parameter N (%) Age (years) 10-14 15-19 20-24 25-29 30-34 35-39 40-44 Outside 10-44 or unknown 1 (1.4) 5(6.9) 9(12.5) 17(23.6) 19(26.4) 13(18.1) 7(1.7) 1(1.4) Parity P0 P1 P2 P3 P4 P5 P6 Unknown 18 (25,0) 19(26.4) 20 (27.8) 9(12.5) 2(2.8) 0(0.0) 2(2.8) 2(2.8) HIV status Non-infected Declined /unknown. Infected On ARVs Not on ARVS 39 (54.2) 11(15.3) 22(30.6) 19(86.4) 3 (13.6) Province Eastern Cape (EC) Free State(FS) Gauteng (GP) Kwazulu-Natal(KZN) Limpopo (LP) Mpumalanga (MP) Northwest (NW) Northern Cape (NC) Western Cape (WC) 6 (8.3) 0(0.0) 27(37.5) 13(18.1) 3(4.2) 5(6.9) 7(9.7) 1(1.4) 10 (13.8) Level of care Outside healthcare facilities Community Healthcare Centre (CHC) District Hospital (DH) Regional Hospital (RH) National & Tertiary Hospitals (NH and TH) Private Hospital (PvTH) 7(9.7) 7(9.7) 25(37.2) 13(18.1) 19(26.4) 1(1.4) Mode of delivery Caesarean section (CS) Normal vaginal delivery (NVD) Unknown 32 (44.4) 26(36.1) 14(19.4) Level of care where CS performed DH RH NH and TH PvTH 7(21.9) 8 (25.0) 14 (43.8) 3 (9.4%) In terms of trend, the iMMR of acute collapse of unknown cause has been on a downward trajectory since 1999 (Figure 1). Figure 1: Eight triennia trends in iMMR for acute collapse of unknown cause 0 2 4 6 8 10 iMMR/100000 livebirths Triennia iMMR for acute collapse-cause unknow for eight triennia from 1999-2022 1999-2001 2002-2004 2005-2007 2008-2010 2011-2013 2014-2016 2017-2019 2020-2022