Review

Maternal deaths from bleeding associated with caesarean delivery: A national emergency

S Fawcus, R C Pattinson, J Moodley, N F Moran, M G Schoon, R E Mhlanga, S Baloyi, E Bekker, G S Gebhardt

Abstract


Maternal deaths associated with caesarean deliveries (CDs) have been increasing in South Africa over the past decade. The objective of this report is to bring national attention to this increasing epidemic of maternal deaths due to bleeding associated with CD in the majority of provinces of the country. Individual chart reviews of women who died from bleeding at or after CD show that 71% had avoidable factors. Among the steps we can take are to improve surgical skills and experience, especially in rural hospitals, to improve clinical observations in the immediate postoperative period and in the postnatal wards, and to ensure that appropriate oxytocic agents are given to prevent postpartum haemorrhage. CEOs and medical managers of health facilities, district clinical specialists, heads of obstetrics and gynaecology, and midwifery training institutions must show leadership and accountability in providing an appropriate environment to ensure that women who require CD receive the procedure for the correct indications and in a safe manner to minimise risks.

Authors' affiliations

S Fawcus, Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of Cape Town, South Africa; Deputy Chairperson, National Committee on Confidential Enquiries into Maternal Deaths, South Africa

R C Pattinson, South African Medical Research Council Maternal and Infant Health Care Strategies Unit and Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of Pretoria, South Africa

J Moodley, Department of Obstetrics and Gynaecology, School of Clinical Medicine, College of Health Sciences, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa

N F Moran, Department of Obstetrics and Gynaecology, School of Clinical Medicine, College of Health Sciences, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa; Department of Health, KwaZulu-Natal, South Africa

M G Schoon, Department of Health, Free State, South Africa

R E Mhlanga, Department of Health, Mpumalanga, South Africa

S Baloyi, Department of Health, Limpopo, South Africa

E Bekker, School of Nursing, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa; Society of Midwives of South Africa

G S Gebhardt, Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Tygerberg, Cape Town, South Africa

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Keywords

Bleeding; Caesarean delivery; Maternal deaths

Cite this article

South African Medical Journal 2016;106(5):472-476. DOI:10.7196/SAMJ.2016.v106i5.10821

Article History

Date submitted: 2016-03-23
Date published: 2016-04-07

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