title: Maternal near miss and maternal death in the Pretoria Academic Complex, South Africa: A population-based study.
abstract: BACKGROUND
  In order to reduce maternal mortality in South Africa (SA), it is important to understand the process of obstetric care, identify weaknesses within the system, and implement interventions for improving care.
  
  
  OBJECTIVE
  To determine the spectrum of maternal morbidity and mortality in the Pretoria Academic Complex (PAC), SA.
  
  
  METHODS
  A descriptive population-based study that included all women delivering in the PAC. The World Health Organization definition, criteria and indicators of near miss and maternal death were used to identify women with severe complications in pregnancy.
  
  
  RESULTS
  Between 1 August 2013 and 31 July 2014, there were 26,614 deliveries in the PAC. The institutional maternal mortality ratio was 71.4/100,000 live births. The HIV infection rate was 19.9%, and 2.7% of women had unknown HIV status. Of the women, 1120 (4.2%) developed potentially life-threatening conditions and 136 (0.5%) life-threatening conditions. The mortality index was 14.0% overall, 30.0% for non-pregnancy-related infections, 2.0% for obstetric haemorrhage and 13.6% for hypertension. Of the women with life-threatening conditions, 39.3% were referred from the primary level of care. Vascular, uterine and coagulation dysfunctions were the most frequent organ dysfunctions in women with life-threatening conditions. The perinatal mortality rate was 26.9/1000 births overall, 23.1/1000 for women with non-life-threatening conditions, and 198.0/1000 for women with life-threatening conditions.
  
  
  CONCLUSIONS
  About one in 20 pregnant women in the PAC had a potentially life-threatening condition; 39.3% of women presented to a primary level facility as an acute emergency and had to be transferred for tertiary care. All healthcare professionals involved in maternity care must have knowledge and skills that equip them to manage obstetric emergencies. Review of the basic antenatal care protocol may be necessary.
authors.affiliation: Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of Pretoria, South Africa, and Steve Biko Academic Hospital, Pretoria. priya.somapillay@up.ac.za.
authors.forename: Priya
authors.initials: P
authors.lastname: Soma-Pillay
authors.forename: Robert C
authors.initials: RC
authors.lastname: Pattinson
authors.forename: Lerato
authors.initials: L
authors.lastname: Langa-Mlambo
authors.forename: Bongani S S
authors.initials: BS
authors.lastname: Nkosi
authors.forename: Angus Peter
authors.initials: AP
authors.lastname: Macdonald