Abstract:
AIMS : Cardiac disease is emerging as an important contributor
to maternal deaths in both lower-to-middle and higherincome
countries. There has been a steady increase in the
overall institutional maternal mortality rate in South Africa
over the last decade. The objectives of this study were to
determine the cardiovascular causes and contributing factors
of maternal death in South Africa, and identify avoidable
factors, and thus improve the quality of care provided.
METHODS : Data collected via the South African National
Confidential Enquiry into Maternal Deaths (NCCEMD)
for the period 2011–2013 for cardiovascular disease (CVD)
reported as the primary pathology was analysed. Only data
for maternal deaths within 42 days post-delivery were recorded,
as per statutory requirement. One hundred and sixty-nine
cases were reported for this period, with 118 complete hospital
case files available for assessment and data analysis.
RESULTS : Peripartum cardiomyopathy (PPCM) (34%) and
complications of rheumatic heart disease (RHD) (25.3%) were
the most important causes of maternal death. Hypertensive
disorders of pregnancy, HIV disease infection and anaemia were important contributing factors identified in women
who died of peripartum cardiomyopathy. Mitral stenosis was
the most important contributor to death in RHD cases. Of
children born alive, 71.8% were born preterm and 64.5% had
low birth weight. Seventy-eight per cent of patients received
antenatal care, however only 33.7% had a specialist as an
antenatal care provider. Avoidable factors contributing to
death included delay in patients seeking help (41.5%), lack of
expertise of medical staff managing the case (29.7%), delay in
referral to the appropriate level of care (26.3%), and delay in
appropriate action (36.4%).
CONCLUSION : The pattern of CVD contributing to maternal
death in South Africa was dominated by PPCM and complications
of RHD, which could, to a large extent, have been
avoided. It is likely that there were many CVD deaths that
were not reported, such as late maternal mortality (up to one
year postpartum). Infrastructural changes, use of appropriate
referral algorithm and training of primary, secondary
and tertiary staff in CVD complicating pregnancy is likely to
improve the outcome. The use of simple screening equipment
and point-of-care testing for early-onset heart failure should
be explored via research projects.
