n Obstetrics and Gynaecology Forum - Avoiding unnecessary caesarean sections : a key strategy for reducing obstetric hemorrhage deaths : review




The Saving Mothers 2008-2010 Report showed a worrying trend of increasing deaths due to obstetric hemorrhage (OH), which is now the second most common category of maternal death in South Africa, (after non-pregnancy related infections), and the most common category of direct maternal death. In particular in 2008-10, there was a big increase in the numbers of maternal deaths associated with caesarean section (CS) bleeding (mainly bleeding after CS). These deaths occurred at all levels of hospital care. The National Committee on Confidential Enquiries into Maternal Deaths (NCCEMD) has resolved to place a special focus on this issue as there has been no reduction in CS-related hemorrhage deaths since 2010, despite the fact that the great majority of these deaths have been assessed as being avoidable. The NCCEMD has released a communication entitled "Alert on Maternal Deaths due to Obstetric Haemorrhage" in which various recommendations have been made to prevent obstetric hemorrhage deaths, with a particular focus on facility requirements for safe CS, intra-operative procedure, post-operative monitoring and algorithms for managing the intra or post-operative bleeding.


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