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Maternal death and caesarean section in South Africa: Results from the 2011 - 2013 Saving Mothers Report of the National Committee for Confidential Enquiries into Maternal Deaths

Gabriel Stefanus Gebhardt, Sue Fawcus, Jack Moodley, Zane Farina

Abstract


Background. In the latest (2011 - 2013) Saving Mothers report, the National Committee for Confidential Enquiries into Maternal Deaths in South Africa (SA) (NCCEMD) highlights the large number of maternal deaths associated with caesarean section (CS). The risk of a woman dying as a result of CS during the past triennium was almost three times that for vaginal delivery. Of all the mothers who died during or after a CS, 3.4% died during the procedure and 14.5% from haemorrhage afterwards. Including all cases of death from obstetric haemorrhage where a CS was done, there were 5.5 deaths from haemorrhage for every 10 000 CSs performed.

Objective. To scrutinise the contribution or effect of the surgical procedure on the ultimate cause of death by a cross-cutting analysis of the 2011 - 2013 national data.

Methods. Data from the 2011 - 2013 triennial review were entered into an Excel database and analysed on a national and provincial basis.

Results. There were 1 243 maternal deaths where a CS was the mode of delivery and 1 471 deaths after vaginal delivery. More mothers died as a result of CS in the provinces where there is a low overall CS rate. The following CS categories were identified as specific problems: bleeding during or after CS, pre-eclampsia and eclampsia, anaesthesia-related deaths, pregnancy-related sepsis and acute collapse and embolism.

Conclusion. This is an area of concern, and a concentrated effort should be done to make CS in SA safer. Several recommendations are made to this effect.


Authors' affiliations

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

Sue Fawcus, Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of Cape Town; Mowbray Hospital, Cape Town, South Africa

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

Zane Farina, Department of Anaesthesia, Nelson Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa; Grey’s Hospital, Pietermaritzburg, South Africa

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Keywords

Confidential enquiry; Caesarean section; Bleeding

Cite this article

South African Medical Journal 2015;105(4):287-291. DOI:10.7196/SAMJ.9351

Article History

Date submitted: 2015-01-06
Date published: 2015-03-10

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