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n Obstetrics and Gynaecology Forum - Obstetric medicine : guest editorial
About 50% of all maternal deaths in South Africa are due to medical conditions. Although the institutional maternal mortality ratio (iMMR) has decreased from 176.22/100 000 live births in 2008-2010 to 154.06/100 000 in 2011-20131, further work needs to be done to reach the Fifth Millennium Development Goal. About 60% of maternal deaths were classified as possibly preventable indicating poor quality of care during the antenatal, intrapartum and postnatal periods. This highlights the importance of quality of care and the need for the continued training of health workers, as well availability of resources to manage the obstetric patients. Maternal mortality and morbidity rates remain high due to various reasons. HIV remains a major problem affecting about 23% of women of child bearing age. About 90% of women who died from non-pregnancy related infections were HIV positive. Obstetric haemorrhage and complications of hypertension in pregnancy continues to be a major cause of mortality, together contributing to about 30% of maternal deaths. As the middle class population increases with improved socioeconomic status, more women delay child bearing to pursue education and careers. Increasing access to assisted reproductive technology has allowed women at an advanced age to conceive. Obesity has become an epidemic in South Africa, with about 70% of women overweight and 42% obese (BMI > 30). These factors contribute to the increased rates of hypertension, diabetes and other chronic conditions affecting pregnancy. There is now an overall improved quality of care for medical conditions such as diabetes mellitus, thyroid disease, polycystic ovarian syndrome and autoimmune conditions such as SLE. As a consequence more women who conceive have chronic medical conditions. It is important that doctors are equipped with the knowledge and skills to optimally manage these women.
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