O&G Forum

OBSTETRICS & GYNAECOLOGY FORUM 2021 | ISSUE 3 | 1 Maternal mortality: An overview Globally, maternal mortality has declined by more than a third from 2000 to 2017 1,2 . However, despite many countries' progress in achieving the Millenium Development Goals, South Africa failed to achieve the target in 2015. While progress has been made in sub-Saharan Africa, the sustainable development goals and the United Nations' Global Strategy for Women's, Children's and Adolescent’s Health (2016-2030) seek to reduce the global maternal mortality ratio (MMR) to 70 deaths per 100 000 live births, while also highlighting the importance of moving beyond survival 3,4 . e probability of reaching this goal in most sub- Saharan Africa is highly questionable, given that most countries have shown little or no change in their MMR. If this is not achieved in a country, the goals are to reduce the 2010 baseline MMR by at least two- thirds and that no country should have an MMR over 140. For every woman who dies from pregnancy-related causes, many more women su er from morbidities, disabilities and ill-health that can last a lifetime. e ve leading causes of maternal deaths (Box 1) in South Africa have remained consistent over ve years. However, since 2011, there has been a signi cant reduction in deaths due to non-pregnancy related infections, which is the reason for the overall reduction in the MMR. On the other hand, deaths due to complications of hypertension in pregnancy remain high despite e ective clinical interventions to prevent and manage all these conditions. In addition, the majority of these deaths occur in health facilities, which should be prepared to handle obstetric emergencies. e other complex issue linked to pregnancy risks, leading to maternal mortality, is gender-based violence, including intimate partner violence. ere is a consensus that homicides and suicides more o en occur during pregnancy than at other times. Timing of maternal death Worldwide, approximately one-quarter of the maternal deaths occur antepartum, another one-quarter occurred intrapartum and immediately a er postpartum, one-third subacute and delayed postpartum deaths. 5 According to Saving Mother's Report 2017, around 64% of the deaths occurred in the postpartum period and 18% in the antenatal period. 6 Twenty-four per cent of the deaths due to hypertension occurred in the antenatal period, whereas 66% occurred in the postpartum period. 6 us, more than 60% of maternal deaths occurred during the postpartum period due to hypertension. e vast majority of these deaths are preventable deaths from hypertensive disorders. erefore, ending preventable maternal mortality remains relevant and fundamental to achieving global developmental goals. e high number of maternal deaths in some areas of the world re ects inequalities in access to quality health services and highlights the gap between rich and poor. O en the circumstances leading to maternal death are complex and multifactorial. e contributory causes are diverse, including the health system, social and developmental factors. Nevertheless, assessors judged that 60% of maternal deaths were preventable, 6 indicating poor quality of care as the healthcare solutions to prevent or manage complications are well known. Preventing maternal mortality e overall reduction in maternal death suggests that continued focus on implementing the recommendation is needed to reduce maternal deaths. • To strengthen access to and improve the quality of antenatal care. • All births are to be attended by skilled health professionals. • Access to postpartum care • All women need access to contraception, safe abortion services and post-abortion care to avoid unwanted pregnancies. Teenage pregnancies and multiparity carry a high risk of maternal death. • Access to basic and higher education for both girls and boys to promote sustainable development in a country. Maternal health care outcomes rely on the health system to be well- coordinated, functional, sustainable and contextual. In addition, achieving positive maternal health outcomes necessitates community engagement and participation. Barriers that limit access to quality maternal health services must be addressed at the health system and societal level. In conclusion, maternal death is a devastating event with catastrophic consequences for the family and society. Maternal health remains a global health issue because the lives of millions of women can be saved during and a er childbirth through maternal health care services. Felicia Molokoane Department of Obstetrics and Gynaecology, University of Pretoria, Pretoria, South Africa Email: felicia.molokoane@up.ac.za References 1. Alkema L, Chou D, Hogan D, et al. Global, regional, and national levels and trends in maternal mortality between 1990 and 2015, with scenario-based projections to 2030: a systemic analysis by the UN Maternal Mortality Estimation Inter-Agency Group. Lancet 2016; 387:462 2. Maternal mortality: Levels and trends 2000 to 2017; 2019 https://www.who.int/reproductivehealth/publications/maternal- mortality-2000-2017/en/ 3. Sustainable development goals [internet]. New York: United Nations; 2015. Available from: http://www.un.org/ sustainabledevelopment/news/communications-material/[cited 2021 Oct 29] 4. Child EW. e global strategy for women's, children's and adolescents health. New York, NY: Every Woman Every Child 2015 5. Kassebaum NJ, Bertozzi-Villa A, Coggeshall MS et. Global, regional and national levels and causes of maternal mortality during 1990- 2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 2014;384:980 6. South African Maternal, Perinatal, and Neonatal Health Policy. June 2021 O&G Forum 2021; 31: 01 EDITORIAL Causes of maternal mortality 1. Non-pregnancy related infections 26.0% 2. Hypertensive disorders 17.8% 3. Obstetric haemorrhage 16.8% 4. Medical & Surgical disorders 12.6% 5. Pregnancy-related sepsis 9.5%