Maternal deaths associated with hypertension in South Africa : lessons to learn from the Saving Mothers report, 2005-2007

Abstract

SummaryFrom 2005–2007, there were 622 deaths associated with hypertensive disorders of pregnancy. Eclampsia was the major cause of death (n = 344; 55.3%). There were 173 (28.3%) deaths due to pre-eclampsia, and 38 (6.1%) associated with chronic hypertension. Cerebral complications were the final cause of death in 283 (45.5%), while cardiac failure and respiratory failure were the final causes in 142 (22.8%) and 158 (25.4%), respectively.Major problems were identified in all areas of assessment. Non-attendance for antenatal care (n = 106; 19.4%) and delay in seeking help (n = 106; 19.4%) were major patient-related factors. Communication problems (n = 63; 10.8%) and lack of facilities (n = 50; 8.5%) were health administration issues. Health worker-avoidable factors included problem recognition, delay in referral and management at an inappropriate level of healthcare.Compared to the previous report of 2002–2004, there was a reduction in deaths due to hypertension.

Barriers Influencing Linkage to Hypertension Care in Kenya: Qualitative Analysis from the LARK Hypertension Study

“…7 Poor linkage to hypertension care, manifested as delays in seeking care after screening and referral, has been shown to be associated with increased mortality among pregnant women in sub-Saharan Africa. 8 Thus, screening and early linkage to hypertension care are critical components of hypertension management.…”

“…7 Poor linkage to hypertension care, manifested as delays in seeking care after screening and referral, has been shown to be associated with increased mortality among pregnant women in sub-Saharan Africa. 8 Thus, screening and early linkage to hypertension care are critical components of hypertension management. However, while linkage to care is known to be a challenge, both in Kenya 9 and elsewhere in sub-Saharan Africa, 10-12 specific factors influencing linkage to hypertension care have not been identified in this population.…”

The role of physical activity during pregnancy in determining maternal and foetal outcomes

“…[12] In South Africa, the latest Saving Mothers Report cited 622 maternal deaths related to hypertensive disorders, with 55.3% from eclampsia, 28.3% from pre-eclampsia and 6.1% associated with chronic hypertension. [13] According to this report, deaths from hypertensive disorders of pregnancy remain the most common direct cause of maternal death. [13] As stated above, since hypertension is closely associated with overweight and obesity, as well as excessive gestational weight gain, there appears to be a need for continual education of women to reduce the risk of developing hypertension, by reducing pre-pregnancy weight and limiting weight gain during pregnancy.…”

“…[13] According to this report, deaths from hypertensive disorders of pregnancy remain the most common direct cause of maternal death. [13] As stated above, since hypertension is closely associated with overweight and obesity, as well as excessive gestational weight gain, there appears to be a need for continual education of women to reduce the risk of developing hypertension, by reducing pre-pregnancy weight and limiting weight gain during pregnancy. [13] Similarly, women who enter pregnancy overweight or obese, or gain excessive weight during pregnancy, have an increased risk of developing GDM.…”

“…[13] As stated above, since hypertension is closely associated with overweight and obesity, as well as excessive gestational weight gain, there appears to be a need for continual education of women to reduce the risk of developing hypertension, by reducing pre-pregnancy weight and limiting weight gain during pregnancy. [13] Similarly, women who enter pregnancy overweight or obese, or gain excessive weight during pregnancy, have an increased risk of developing GDM. [10] Although little is known about GDM in Africa, a recent systematic review reported a prevalence ranging from 0-13.9%, and an estimated 8.8% in South Africa.…”