Maternal Deaths
The guidelines recommend management of common obstetric conditions at primary and referral level, based on local experience and evidence-based practice. They are not intended as strict protocols nor as standard operating procedures, but rather as a guide to safe effective management of common obstetric problems. The guidelines should be most useful to interns, medical officers and registrars.
Maternal death is defined as death of a woman while pregnant or within 42 days of delivery. This is, by law, a notifiable event in South Africa.
Procedure for maternal death
- The nursing staff usually arrange notification of the next of kin of the deceased
- All maternal deaths must be reported as soon as possible to the head of department by the doctor on duty at the time of the death
- The relatives should be counselled by the doctors & nurses involved &, if necessary, asked for permission to submit the body for autopsy
- The case should be discussed at the next M&M meeting
- The maternal death must be notified to the provincial authorities on the maternal death notification form
Procedure for autopsy after maternal death
- Inform the departmental secretary as soon as possible about plans for autopsy
- Counsel the next of kin about the need for autopsy & ask their permission
- Complete the autopsy consent form with the next of kin
- Complete the hospital autopsy application form
- Complete the laboratory services autopsy request form
- Contact the pathology registrar on duty to arrange any further details
- All completed forms are taken to the mortuary
- A doctor from the department should be in attendance at the autopsy
MATERNAL DEATH NOTIFICATION
Maternal deaths are, by law, notifiable. A maternal death is defined as the death of a pregnant woman, irrespective of gestation, or the death of a woman less than 42 days after the end of her pregnancy. Whether or not the death is related to the pregnancy, notification is mandatory. At each institution that offers care to pregnant women, a person (doctor or midwife) should be nominated to take responsibility for the notification of maternal deaths, and should keep a supply of maternal death notification forms, which are available from provincial directorates of maternal and child health.
Procedure for maternal death notification
- Complete the maternal death notification form
- Attach photocopies of all the deceased’s clinical notes
- Place the notification form and the photocopied notes in an envelope, clearly labelled ‘confidential’
- Send the envelope by courier to the Gauteng provincial maternal and child health directorate, within 7 days of the death
- Keep the original clinical notes in a safe place
- Keep a photocopy of the notification form in a safe place, separate from the clinical notes
All maternal deaths are assessed by provincial assessors who forward their assessments to the National Committee for Confidential Enquiries into Maternal Deaths (NCCEMD). All notifications & assessments are treated in strict confidence & are destroyed after entry into the Confidential Enquiries database. The hospital & health workers involved in the maternal death cannot be identified from the Confidential Enquiries database.
The NCCEMD regularly releases publications in which maternal death statistics & trends are presented.