Maternal mortality in a tertiary center after introduction of free antenatal care

OBJECTIVE: Determination of maternal mortality rate (MMR) and the main causes of maternal death after the implementation of free antenatal care in a tertiary center in South Africa. METHODS: Retrospective case study on maternal deaths from 1 January 1993 to 31 July 1997. RESULTS: The maternal mortality rate was 128/100000 births. Hypertension disorders (18%), hemorrhage (18%) and sepsis (13%) were the most important causes of death; 44% of all deaths were considered preventable. CONCLUSIONS: The high percentage (44%) of preventable deaths is a cause of concern and is the result of increased workload, decreased staff numbers and late referrals with low socio-economic class of the patient. The discrepancy in the mortality rate between patients booked at the tertiary institution (29.8/100000) and patients booked elsewhere (304.7/100000) or not booked at all (348.5/100000) indicates the need for improving antenatal care in the periphery.