17-fold: the number of stillbirths among mothers whose pregnancy ended in death at Bara

Public health specialists have labelled the death rate of infants born to sickly mothers at Chris Hani Baragwanath Hospital in Soweto, Johannesburg, as “concerning and troubling”, with the latest figures showing early neonatal death to be 12 times the national average. 

The stillbirth rate among mothers whose pregnancy ended in death at that hospital over a five-year period was 17 times the national average, prompting researchers to call for evaluation and enhancement of prenatal care to improve the health of women who have other medical conditions. 

According to the Wits university study that was conducted between 2014 and 2019 to determine the causes of maternal deaths and pregnancy-related outcomes — the first to routinely collect such data — researchers found that maternal deaths had more catastrophic birth outcomes even when compared to high-risk populations at that hospital. 

“Our study highlights the dire perinatal outcomes associated with maternal death, as the perinatal mortality rate (PMR) in this group is 12 times higher than that of the general population. The study also revealed extremely high stillbirth and early neonatal deaths rates,” noted lead researcher Nomshado Msibi-Afolayan from the Wits University department of obstetrics and gynaecology. 

The World Health Organisation (WHO) explains the perinatal mortality rate (PMR) as the number of deaths of foetuses weighing at least 500g or gestational period of about 22 weeks, or the number of early neonatal deaths. In this study, PMR was 388 per 1,000 births. 

Of about 147 maternal deaths in the study, hypertension was a major cause of deaths with its complications resulting in about 37% of deaths of mothers, followed by pregnancy-related sepsis that caused about 27% of deaths.

Obstetric haemorrhage caused just more than 20% of deaths. Of non-pregnancy-related infections that resulted in death of mothers, HIV was leading, followed by medical and surgical disorders. 

Maternal mortality ratio at Chris Hani Baragwanath Hospital was also found to be much higher than the national average at 135 per 100,000 live births compared to about 113 per 100,000 live births during the study period.

The majority or over 80% of women died post-partum. Only 14 women died before their delivery. 

The stillbirth rate was 347 per 1,000 births with maternal death, which is 17 times higher than the national rate and 14 times higher than the average stillbirth rate at Chris Hani Baragwanath Hospital

“The early neonatal death rate of 66 per 1,000 live births with maternal death was equally troubling, at six times higher than the national rate and five times higher than the rate for (that) hospital population during the study period,” researchers wrote in the South African Medical Journal. 

While sick mothers are more likely than healthy mothers to have sick foetuses or have full-term pregnancies, researchers pointed to the fact that the study took place at a tertiary hospital that deals with a high-risk population, could be a contributing factor to the high numbers of adverse pregnancy outcomes. 

“Furthermore, many of the babies in this study were preterm and vulnerable to the associated complications, which can lead to death.” 

Prematurity was the major driver of baby deaths in this study with more than half of the infants of low birthweight, and almost two-thirds were stillborn. Researchers said the latest causes of the deaths in the study were similar to maternal deaths in the 2017-2019 Saving Mothers and Babies report. Researchers said while strides have been made in initiation of antiretroviral therapy for HIV, “we need to focus on opportunistic infections and adherence to treatment”. 

“We suggest that routinely collected data on maternal deaths include perinatal outcomes as a standard. Prenatal care may assist in optimising the health of women with comorbidities, and future research needs to evaluate prenatal care and its effects on preventing maternal deaths and thus improving perinatal outcomes.”

“More work also needs to be done to improve HIV programmes and prevent HIV-related opportunistic infections, as these are still a leading cause of maternal death and poor perinatal outcomes,” said researchers.