The objective of this study was to identify the frequency, causes, and avoidable factors of severe acute maternal morbidity (SAMM) in four non-specialist hospitals in rural South Africa. A prospective audit was conducted using criteria for SAMM suited to the diagnostic and treatment facilities available in the primary hospital setting. For each case of SAMM, a local audit team assessed the standard of care against local management guidelines and examined avoidable factors. An external specialist also retrospectively examined avoidable factors. The facility-based incidence of SAMM was 541 cases per 100,000 births (95% CI 368–767). The commonest organ systems involved were cerebral (42%), coagulation (19%), and vascular dysfunctions (16%). The commonest obstetric diagnoses were eclampsia (39%) and obstetric haemorrhage (32%). Approximately 65% of cases were avoidable.The study concluded that a qualitative case review audit of SAMM in a non-specialist rural setting appears feasible and sustainable, and provides valuable information towards improving deficiencies in maternal care.
Gandhi, M.N.; Welz, T.; Ronsmans, C. Severe acute maternal morbidity in rural South Africa. International Journal of Gynecology and Obstetrics (2004) 87 (2) 180-187. [DOI: 10.1016/j.ijgo.2004.07.012]