Maternal deaths due to acute collapse of unknown cause during the 2020-2022 triennium

Objective: To describe the profile, causes, and avoidable factors associated with maternal deaths due to acute collapse of unknown origin during the triennial period 2020 to 2022. Methods: Data on maternal deaths resulting from acute collapse of unknown cause for the triennial period 2020-2022 was extracted from the Maternal Morbidity and Mortality Audit System (MaMMAS) database and analysed using descriptive statistics(absolute numbers and frequencies). Permission to publish the study was granted to the National Committee on Confidential Enquiry into Maternal Deaths (NCCEMD) by the Department of Health. Results: There were 3,019,165 deliveries and 3,803 maternal deaths, 72 (1.9%) of which were due to acute collapse of unknown cause, making it the 11th most common cause of maternal mortality during this period. Half of the women (36, 50.0%) were in the age group 25 to 34 years. The majority of the women who died had a parity of zero to two (57, 79.2%) and were HIV non-infected (39, 4.2%). Slightly just over a third (25, 34.7%) of the deaths occurred in district hospitals, followed by central and tertiary hospitals (19, 26.4%). Only 14 (43.8%) of the women who died delivered via caesarean sections. The highest incidence of institutional maternal mortality ratio (iMMR) was observed in the age groups 10-14 and 40-44 years. The final cause of death remained unknown in 26 cases (36.1%). Patient-related (24, 38.1%), administrative (26, 41.3%), and resuscitation-related avoidable factors (23, 63.5%) were found in 63 of the cases that were assessed. These factors need to be addressed in order to reduce maternal mortality due to acute collapse of unknown cause. Conclusion: While the trend shows a downward trajectory, maternal deaths due to acute collapse of unknown cause remain a public health concern, and the underlying cause in many of the cases remain unknown despite clinical assessments, investigations, and post-mortem examinations. The above underscore the importance of public awareness regarding associated risk factors and preventative strategies such as family planning, healthcare worker training in resuscitation skills, and quality assurance in performing post-mortem examinations.