This is according to the Saving Mothers report that summarises findings on the confidential enquiries into maternal deaths in South Africa between 2008 to 2010.

The ‘€œbig 5’€ accounted for 86.5% of maternal deaths ‘€“ Non Pregnancy Related Infections (NPRI) at 40.5% was by far the biggest factor.

The majority of these NPRI conditions were diagnosed before birth (59.7%), but the majority of deaths occurred after the births (60.6%).

Respiratory tract infections (tuberculosis, pneumocystis pneumonia and other pneumonias) contributed to almost three quarters (67%) of the NPRI deaths followed by meningitis (12.9%) and gastroenteritis (5.2%).

Researchers noted that complications of antiretroviral therapy, although fairly rare, increased significantly in 2010 when compared with 2008 and 2009 with liver complications and Stevens – Johnson syndrome the most common.

Respiratory failure (64%) and cerebral complications (17.9%) were the most common final NPRI causes of maternal deaths.                  

HIV infection was the most common contributory condition with 87.3% of the women being HIV infected, 5.2% HIV negative, 0.7% declined testing and in 6.8% the status was unknown. In this group 69% had AIDS (defined as a CD4 immunity count below 200).

The report identified the delay in accessing medical help and poor or no antenatal care attendance as further patient-related factors. The most common administrative avoidable factor was lack of appropriately trained staff doctors and nurses (6.2%) and lack of intensive care unit facilities (3.7%).

Obstetric haemorrhage was the second most common cause of maternal death, accounting for 688 deaths or 14.1% of the total. This is considered to be an avoidable cause of death involving bleeding during and after caesarean section.

The latest figure compared with 491 deaths in the 2005-2007 period. The haemorrhage related maternal mortality ratio (MMR) was 24.9 deaths per 100,000 live births, which is an increase from 18.8 in 2005-2007 and 20.7 in 2002- 2004. There was considerable provincial variation with the greatest numbers of haemorrhage deaths occurring in Eastern Cape, Gauteng and Limpopo and lowest in the Western Cape.

Complications of hypertension in pregnancy (14%), pregnancy related sepsis (9.1%) and medical and surgical disorders were the other major contributors to death.

The Saving Mother committee summarised its recommendations as the ‘€œ5 H’€™s’€ that could have a major impact on the escalating maternal mortality rates ‘€“ HIV/AIDS, haemorrhage, hypertension, health worker training and health system strengthening.

The interventions include addressing HIV/AIDS through early testing and access to antiretrovirals, preventing severe haemorrhage by making it a major alert requiring immediate attention, recognising hypertension as life threatening, training all health care workers in maternity care and ensuring 24 hour access to functioning emergency obstetric care.