AFJOG

African Journal of Obstetrics and Gynaecology | Volume 3 | Issue 1 | 2025 | 30 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 embolism (amniotic fluid and pulmonary), haemorrhage, septic shock, medication errors, myocardial infarction, mechanical valve thrombosis, acute aortic dissection, cerebrovascular incidents, anaphylaxis, and complications related to anaesthesia. 4 The fact that the cause of death in over one-sixth of the maternal deaths in this study remained undetermined, highlights the challenges in the diagnosis and management of these cases and underscores the need for further research. Most women who died were HIV uninfected. This is in contrast to the reported increased risk of pulmonary embolism among HIV-infected women, a known cause of maternal acute collapse. 19 Therefore, family planning remains a critical intervention to prevent unplanned pregnancies20 and reduce the risk of death, especially among extremes of age, the groups with the highest maternal acute collapse of unknown cause related to iMMR. This should be supported by public education on associated risk factors, the importance of early antenatal booking and antenatal clinic attendance, and training healthcare workers to improve their knowledge and skills in maternal resuscitation. Conducting post-mortem examinations for women who die from acute collapse of unknown cause should be encouraged and those performing postmortem examinations should be supported and trained to reduce the number undiagnosed cases. Investing in these strategies could help South Africa reduce maternal mortality to less than 70 per 100,000 live births by the year 2030. 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 of many cases remains unknown following clinical assessments, investigations, and post-mortem examinations in a proportion of cases . This underscores the need for public awareness regarding risk factors and preventative strategies such as family planning, healthcare worker training in resuscitation skills, and quality assurance in performing post-mortem examinations. KEY RECOMMENDATIONS 1. Risk Assessment and Monitoring: Train healthcare professionals to identify risk factors during pregnancy, to initiate appropriate interventions and conduct ongoing monitoring. 2. Resuscitation Techniques: Ensure all healthcare providers working in maternity units are trained in maternal resuscitation , including participation in regular simulation drills. 3. Safe Anaesthetic and Surgical Techniques: Train healthcare workers in safe anaesthetic and surgical practices, especially in district, regional, and remote hospitals. 4. Contraceptive Coverage: Improve contraceptive access and education to reduce unintended pregnancies, particularly among young and older women. 5. Urgent Action: Politicians, civil society, educators, communities, healthcare professionals, and stakeholders prioritise prevention of teenage pregnancies through education and establishment of youth friendly sexual and reproductive health (SRH) services. 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 Saving Mothers' Reports and making valuable recommendations. REFERENCES ¤ ¤ £ £¡ ¡¡ ¡ ¡ ¡ ¡ ¡ _ ¡ ¢ ££ ¨ ¨ « ¡ ¦ ¡ £ £ ¡ £ £ £ £ £ ® ¦ ¤ ¦ ³ ´ « ¡¡ ¡¦ ¡ ¡ ¡ ¢ ¡ ¦ ¤¥ ¡¡ ¦ ¡ ¡ ¡ ¡¡ ¡ ® £« £ £ « ¡¡ ¦ ¡ ¡ ¦ ¡ ¡ ¡ ® £ ¡ ¦ £ ¨ £ ¡¡ ¡ ¡ £ ¨ © ¦ ª « £ ¡¡ ¡ ¡ ¦ ¥ ¡¡ ¡ ¡