Neonatal deaths at Chris Hani Baragwanath Hospital were as much as 12 times the national average, while the stillbirth rate among mothers whose pregnancy ended in death over a five-year period was a staggering 17 times the national average, a study by Wits University has found.
Public health specialists have labelled the death rate of infants born to sickly mothers at the hospital as “concerning and troubling”, with researchers calling for evaluation and enhancement of prenatal care to improve the health of women with other medical conditions, reports TimesLIVE.
In the Wits study, conducted between 2014 and 2019 to determine the causes of maternal deaths and pregnancy-related outcomes, and the first to routinely collect such data, researchers found maternal deaths had more catastrophic birth outcomes even when compared with high-risk populations at that hospital.
“Our study highlights the dire perinatal outcomes associated with maternal death, with the perinatal mortality rate (PMR) in this group being 12 times higher than that of the general population,” noted lead researcher Nomshado Msibi-Afolayan from the Wits department of obstetrics and gynaecology.
The WHO definition of perinatal mortality rate (PMR) is the number of deaths of foetuses weighing at least 500g or gestational period of about 22 weeks, or the number of early neonatal deaths. In this study, the PMR was 388 per 1 000 births.
Of 147 maternal deaths, hypertension was a major cause, with its complications resulting in about 37% of deaths of mothers, followed by pregnancy-related sepsis causing about 27% of deaths.
Obstetric haemorrhage was responsible for just more than 20% of deaths. Of non-pregnancy-related infections causing the death of mothers, HIV led, followed by medical and surgical disorders.
The maternal mortality ratio at Bara was also much higher than the national average at 135 per 100 000 live births compared with about 113 per 100 000 live births during the study period.
The majority – or more than 80% of women – died post-partum. Only 14 women died before their delivery.
“The early neonatal death rate of 66 per 1 000 live births with maternal death was equally troubling, at six times higher than the national rate and five times higher than the rate for (that) hospital population during the study period,” the researchers wrote in the South African Medical Journal.
While sick mothers are more likely than healthy mothers to have sick foetuses or have full-term pregnancies, researchers said the fact that the study was carried out a tertiary hospital dealing with a high-risk population could be a contributing factor to the high numbers of adverse pregnancy outcomes.
Also, many of the babies were preterm and “vulnerable to the associated complications, which can lead to death”.
Prematurity was the major driver of baby deaths in this study with more than half of the infants of low birthweight, and almost two-thirds were stillborn.
Study details
Perinatal outcome of maternal deaths at Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa, January 2014 – June 2019
N Msibi-Afolayan, M Nchinyani, M Nchinyani and Y Adam.
Published in the SA Medical Journal on 4 September 2023
Abstract
Background
Maternal death is a tragic event. Of maternal deaths worldwide, 99% occur in low- and middle-income countries. Perinatal outcome is related to maternal well-being. Maternal death has a negative impact on foetal and neonatal outcome in the short and long term.
Objectives
To determine the perinatal outcomes of pregnancies that ended in a maternal death at Chris Hani Baragwanath Academic Hospital (CHBAH), Johannesburg, South Africa, over a 5-year period, to describe the causes of maternal death, and to determine the stillbirth rate (SBR) and early neonatal death (ENND) rate in this population.
Methods
This was a retrospective cross-sectional study of maternal deaths in women with a viable pregnancy from January 2014 to June 2019 at CHBAH. All maternal deaths with gestation >26 weeks or foetal weight >500 g were included in the study. Information on demographics, booking status, antenatal care, pregnancy outcome, and foetal and neonatal outcome was extracted from maternal and neonatal files.
Results
Of a total of 183 maternal deaths during the study period, 147 were included in the study. The institutional maternal mortality ratio was 135 deaths per 100 000 live births. Hypertension was the main direct cause of death (36.5%; n=27/74), followed by pregnancy related sepsis (27.4%; n=21/74) and obstetric haemorrhage (20.6%; n=15/74). Non-pregnancy-related infections, of which 91.4% were HIV and HIV-related complications, comprised 47.9% (n=35/73) of indirect causes of death, followed by medical and surgical disorders. Of a total of 151 babies, including two sets of twins and one set of triplets, 137 were delivered and 14 were undelivered at the time of maternal death. Ninety-one babies (61.9%) were born alive and 51 (34.6%) were stillbirths. Of the 91 liveborn infants, 6 (6.5%) had an ENND. Of the 51 stillbirths, 14 (27.5%) were undelivered and 11 (21.6%) were delivered by perimortem caesarean section. The SBR was 347 per 1 000 maternal deaths and the ENND rate 66 per 1 000 live births. The perinatal mortality rate (PMR) was 388 per 1 000 maternal deaths, which is 12 times higher than the PMR per 1 000 live births for the general population.
Conclusion
Women who experience maternal death have babies with very poor perinatal outcomes, with a very high SBR, ENND rate and PMR. The health of the mother has a direct and significant effect on foetal and neonatal outcomes.
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