title: Severe acute maternal morbidity in rural South Africa.
abstract: 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.
authors.affiliation: Bethesda Hospital, Mkuze, KwaZulu-Natal, South Africa.
authors.forename: M N
authors.initials: MN
authors.lastname: Gandhi
authors.forename: T
authors.initials: T
authors.lastname: Welz
authors.forename: C
authors.initials: C
authors.lastname: Ronsmans
mesh_terms: 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