The prevention of maternal deaths: a continuing challenge.

This report studies the principal causes of maternal death at Harare Maternity Hospital. In 1983 the maternal mortality rate for the greater Harare unit was 52/100,000 compared to 11.9/100,000 for England and Wales. Puerperal sepsis, hemorrhage, post-abortal sepsis and hypertensive disease accounted for 78.5% of the deaths. 12 of the deaths were due to puerperal sepsis, 8 of which had normal vaginal delivery and 4 were delivered by Caesarian section. 3 patients died within 48 hours of delivery. Hemorrhage was most commonly a result of ruptured uterus. Avoidable factors were considered present in all cases. Delay in diagnosis, availability of blood or performing laparotomy was evident in 4 of 5 who died from ruptured uterus; 2 were due to pulmonary edema from excessive transfusion, and 2 were attributable to the patient (refusal of transfusion, attempt to self abort.) Post-abortal sepsis occurred in 9 patients, most of whom were septicemic on admission. 8 patients died from hypertensive disease, 7 of which were eclamptic. Reduction in mortality has gone from 34% (1976) to 23.7% (1983) for puerperal sepsis and can be affected by encouraging patients to book for antenatal care. An observed increase in hemorrhagic deaths since 1976 may reflect a decreased staff-patient ratio at Harare Maternity Hospital. Post-abortal sepsis mortality has decreased from 32% (1976) to 17.7% (1983). Reduction in deaths from hypertensive disease necessitates prediction and early detection. Value of a post-mortem exam in all cases of maternal death is stressed.