Increase in Embolism Related Maternal Deaths During the 2020-2022 Triennial Period in South Africa: A cause for concern

Background: Embolism is increasingly becoming recognized as an important cause of maternal mortality worldwide and the leading cause of maternal deaths in high-income countries (HICs) such as the United States and the United Kingdom. Despite the rising prevalence of embolismrelated risk factors among pregnant women in Africa, there is a scarcity of data on embolism related maternal deaths from this region. Aim: To describe the profi le of women who succumbed to embolism during the 2020-2022 triennium, along with associated risk and avoidable factors. Methods: Data from the Maternal Morbidity and Mortality Audit System (MaMMAS) database, together with hard copies of clinical records of women who died during the study period, were extracted and analysed using descriptive statistics. Additionally, Saving Mothers reports from 1999 to 2019 were reviewed to assess trends. Permission to publish the study was granted to the National Committee on Confi dential Enquiries into Maternal Deaths (NCCEMD) by the National Department of Health (NDOH). Results: During the study period, there were 3,019,165 deliveries and 3,803 maternal deaths, of which 116 (3.1%) were attributed to embolism, 102 (87.9%) and 14 (12.1%) of which were due to pulmonary and amniotic fl uid embolism respectively. The majority of the women who died due to pulmonary embolism were aged between 25 and 39 years (81, 69.8%) and had attended antenatal clinics (88, 75.9%). Only 43 (42.2%) delivered via caesarean section. Among the women with risk factors, the identifi ed risk factors included obesity, hypertensive disorders of pregnancy, and caesarean section delivery. Patient-related, administrative, and resuscitation-related issues were identifi ed in 38 (32.8%), 37 (31.9%), and 43 (37.1%) of the maternal deaths, respectively. Addressing these factors is critical for reducing maternal deaths related to embolism in South Africa. Conclusion: Maternal deaths from embolism increased during the 2020 to 2022 period compared to the previous years. This trend underscores the need for nationwide risk assessment strategies, including risk-based thromboprophylaxis.