Maternal mortality from COVID 19 among South African pregnant women

Abstract

Objective

To determine the COVID 19 related maternal deaths among South African pregnant women at Ekurhuleni health district in South Africa and to compare with similar studies.

Study design

Retrospective review of all maternal deaths from all health care facilities from April to September 2020 were conducted using COVID registers and maternity case records. Human Research Ethics Committee of the University of Witwatersrand approved the study. Data included total live births, maternal mortality ratio (MMR), age, ethnicity, place of admission, parity, pregnancy status, antenatal complications, gestational age (GA) at delivery, GA at COVID 19 diagnosis, GA at death, symptoms, comorbidity, investigations (HIV, platelets, lymphocytes and LDH), and fetal outcome. Descriptive statistics (mean ± standard deviation, number and percentages) were calculated.

Results

Six women died from COVID. All were African. Mean age was 33.5 (SD ± 4.3) years majority (83%) were multiparous. The mean GA at the time of diagnosis was 35 (± 5.8) weeks. All had dyspnea at presentation. All had hypertension. HIV rate (50%) was higher than the national rate. High lactic dehydrogenase was the commonest laboratory abnormality. Rate of macerated stillborn (66%) was very high.

Conclusion

To date, there are no African studies reporting on maternal mortality from COVID 19. This study provided valuable insight into maternal deaths due to COVID among South African women. COVID 19 is a novel cause of maternal death that has increased the death rate among South African pregnant women. Hypertensive women are at increased risk of death. They should be routinely tested for COVID. Women are at risk of death during the third trimester of pregnancy. High rate of stillborn is a concern. Decision to deliver earlier should be an option. High HIV rate and LDH count should alert health care workers to perform these tests among all COVID positive mothers.

Keywords:

• COVID 19
• maternal mortality
• Africa
• pregnancy
• fetal

Acknowledgments

The authors acknowledge all health care workers at the Ekurhuleni district for their moral support and good record keeping.

Disclosure statement

No potential conflict of interest was reported by the author(s).