Maternal Death and Postpartum Death in Maputo Mozambique - a Retrospective Autopsy Study

Introduction

Maternal mortality (MM) in Sub-Saharan Africa is ≈100-fold higher compared to developed countries. Postpartum hemorrhage (PPH) is estimated to cause 30-50% of deaths.

Aim

To determine the direct contribution of PPH to MM in Mozambique.

Methods

Analysis of autopsy reports of pregnant women who died at Hospital Central Maputo (HCM) between 01/2018 and 01/2022. Extracted data included age, labs and vitals on admission, delivery characteristics, HIV status, and causes of death. Direct causes of MM were split into 5 classifications: PPH, hypertensive diseases, indirect, infection/sepsis, and others.

Results

Based on known mortality rates ≈200 autopsy reports were expected for analysis, but only 64 were available; 8 were excluded for prepartum death. PPH occurred in 22/56 women (39.3%) and was the direct cause of death for 17/56 (30.3%). Figure 1 shows the proportion of direct causes of peri/postpartum death, whereby PPH and hypertensive diseases (28.6%) caused ≈2/3rd of deaths. Labs on admission were available for 39 women. Women who later experienced PPH had lower median hemoglobin (8.6 vs 10 g/dL, p=0.046) and platelets (127,500 vs. 187,000/uL, p=0.039) compared to those who did not.

Conclusion

PPH occurred in ≈40% of dying pregnant women and was documented as the direct cause of death in almost all, with more anemia and thrombocytopenia on admission. Difficulties to locate autopsy reports, and the limited availability of tranexamic acid and blood products reveal the need for infrastructural support, prospective studies, and PPH prevention/intervention protocols to effectively reduce maternal mortality in Sub-Saharan Africa.

von Drygalski:Novo Nordisk: Consultancy, Honoraria; Genentech: Consultancy, Honoraria; Takeda: Consultancy, Honoraria; Sparx Therapeutics: Consultancy, Honoraria; Biomarin: Consultancy, Honoraria; Regeneron: Consultancy, Honoraria; Hematherix LLC: Other: Co-founder; Bioverativ/Sanofi: Consultancy, Research Funding; Pfizer: Consultancy, Research Funding; CSL-Behring: Consultancy, Honoraria.