Severe acute maternal morbidity in rural South Africa.
OBJECTIVE
Our objective was to identify the frequency, causes, and avoidable factors of severe acute maternal morbidity (SAMM) in four non-specialist hospitals in rural South Africa.


METHODS
We conducted a prospective audit 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.


RESULTS
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.


CONCLUSIONS
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
MN
Bethesda Hospital, Mkuze, KwaZulu-Natal, South Africa.
Welz
T
T
Ronsmans
C
C
D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D008427:Maternal Health Services / Q000706:statistics & numerical data*; D008428:Maternal Mortality; D008485:Medical Audit; D011247:Pregnancy; D011248:Pregnancy Complications / Q000401:mortality*; D011446:Prospective Studies; D012189:Retrospective Studies; D019035:Rural Health Services / Q000706:statistics & numerical data*; D013019:South Africa / Q000453:epidemiology