AFJOG

African Journal of Obstetrics and Gynaecology | Volume 3 | Issue 1 | 2025 | 29 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 Gauteng, Northwest, and the Western Cape provinces had the highest iMMR for maternal acute collapse of unknown cause (Figure 2). Similar observation was made on the age groups 10-14 and 40-44 years (Figure 3). Figure 2: iMMR for acute collapse-cause unknown per province during 2020-2022 triennium 0.0 0.5 1.0 1.5 2.0 2.5 3.0 3.5 4.0 4.5 EC FS GP KZN LP MP NW NC WC iMMR/100000 livebirths Province iMMR forAcute collapse - cause unknown per province from 2020-2022 triennium Figure 3: iMMR for acute collapse -cause unknown per age group 2020-2022 triennium 0.0 1.0 2.0 3.0 4.0 5.0 6.0 7.0 8.0 9.0 10.-14 15-19 20 - 24 25 - 29 30 - 34 35 - 39 40 - 44 Outside 10-44 range & Unk iMMR/100000 livebirths Age range iMMR for Acute collapse - cause unknown per age range - 2020-2022 triennium A postmortem examination was conducted on 39 women, representing 54.2% of the cases. Based on clinical assessments and the results of the postmortem examinations, the most prevalent final causes of maternal deaths attributed to acute collapse were undetermined in 26 women (36.1%). This was followed by respiratory failure in 15 women (20.3%), embolism in nine women (12.5%), circulatory failure in seven women (9.2%), and cardiac failure in six women (8.3%) as detailed in Table 3. Table 3: Final causes of deaths Final cause of death N (%) Circulatory failure 7(9.2) Respiratory failure 15 (20.3) Cardiac failure 6(8.3) Embolism 9(12.5) Renal failure 1 (1.4) Cerebral complications 4(5.6) Metabolic 1 (1.4) Haematological 2 (2.8) Immune 1 (1.4) Unknown/other 26(36.1) Table 4 provides a summary of the avoidable factors identified in the study. Out of 72 cases, 63 (87.5%) had sufficient information enabling assessment of avoidable factors. Patient-related factors were identified in 24 (38.1%), administrative factors in 26 (41.3%), and resuscitation-related issues in 23(36.5%) of the maternal deaths. The most common patient-related avoidable factors were lack of antenatal care identified in 12 (50.0%) and delays in seeking assistance in 10(41.7%) women. Among the administrative factors, the predominant causes were classified as "other” in nine (34.6%), lack of healthcare facilities in four (15.4%), lack of transportation in three (11.5%), and insufficient skills in three (11.5%) women. The database did not have information on what constituted ‘other’. Resuscitation-related avoidable factors encompassed challenges in managing breathing reported in four ( 17.4%), circulation in five (21.7%), and monitoring two ( 8.7%) of the women who died. Table 4: Avoidable factors Final cause of death Total number (N=63) % Patient related avoidable factors Avoidable factors present No avoidable factors Lack of information 24 30 9 38.1 47.6 14.3 Administrative related avoidable factors Avoidable factors present No avoidable factors Lack of information 26 28 9 41.3 44,4 14.3 Resuscitation related avoidable factors Avoidable factors present No avoidable factors Lack of information 23 31 9 36.5 49.2 14.3 DISCUSSION In this study, we reviewed maternal deaths due to acute collapse of unknown cause during the 2020-2022 triennium. Acute collapse ranked as the 11th most common cause of maternal mortality, accounting for 1.9% (2.4 per 100 000 births) of all maternal deaths during the period under review. This figure is less than the global estimated incidence of 14 to 600 per 100,000 births. In South Africa, the trend in acute collapse-related maternal deaths has been decreasing since 1999. This could be due to improved diagnosis due and better used of postmortem examination. This is further suggested by the corresponding increase in the category of maternal deaths due to pulmonary embolism during the same period. Half of the women who died were in the age group 25- 34 and 35-39 years respectively . Majority of the women were HIV-uninfected and had a parity of zero to two. Only 44.4% delivered via caesarean section in the index pregnancy. Although acute collapse is not predictable, factors such as advanced maternal age (35 years and older), obesity, co-morbidities, delivery via caesarean section and substance abuse, have been associated with an increased risk. While not all the risk factors were present in our study, the importance of risk assessment during pregnancy cannot be overemphasised. A systematic review by Sobhy et al. 14 reported that the risk of a woman dying from complications of anaesthesia during an obstetric procedure was 1.2 per 1,000 women in LMICs, identifying lack of skills as the most common avoidable factor. An audit of maternal deaths at Windhoek Central Hospital found a 2% prevalence of anaesthetic-related deaths, attributing the deaths to adverse drug reactions from Bupivacaine. 15 Similarly, lack of skills is among the leading cause of anaesthetic and surgical- related maternal deaths in South Africa. 16,17 The highest iMMR in this study was amongst the age groups 10-14 and 40-44 years. This observation is likely a reflection of inadequate access to contraception, insufficient education regarding contraceptive use, poor contraceptive uptake, or a combination of these factors. Furthermore, the high iMMR observed among teenage mothers in this study is a public health concern given the growing number of teenage pregnancies reported in South Africa. 18 A total of 39 (54.2%) women who died had postmortem examinations; however, the cause of death remained unknown in 26 cases (36.1%). The most commonly reported causes of acute collapse during pregnancy include