PB1513 - Post-Partum Hemorrhage and Maternal Death in Mozambique - an Autopsy Study

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

Aims: 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, comorbidities, complications, and causes of death. Direct causes of MM were split into 5 classifications: PPH, hypertensive diseases, indirect (exacerbated preexisting condition causing death), infection/sepsis, and others. The study was approved by the Human Research Protections Program at the University of California San Diego and the Institutional Bioethics Committee of HCM.

Results: Based on known mortality rates ≈200 autopsy reports were expected for analysis, but only 51 were available; 7 were excluded for prepartum death. Table 1 shows population characteristics.

PPH occurred in 16/44 women (36.3%) and was the direct cause of death for 13/44 (29.5%). Figure 1 shows the proportion of direct causes of peri/post-partum death, whereby PPH and hypertensive diseases (31.8%) caused ≈2/3rd of deaths. Labs on admission were available for 32 women. Women who later experienced PPH had lower median hemoglobin (8.6 vs 9.8 g/dL, p=0.08) and platelets (139,000 vs. 178,000/u, p=0.16) compared to those who did not. Protocols to estimate peripartum blood loss were not used; antifibrinolytics and/or blood products were not always available.

Conclusion(s): PPH occurred in ≈1/3rd 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.