Anaesthesia-related maternal deaths in South Africa Chapter Seven of the 5th Saving Mothers Report 2008-2010

The number of reported deaths due to anaesthesia continues to increase. There were 121 reported this triennium. This represents 2.5% of all maternal deaths and 5.4% of deaths directly related to complications of pregnancy. One hundred and eighteen of these were available for review and 92 were assessed as being directly due to anaesthesia. Spinal anaesthesia accounted for 73 (79%) of the deaths and general anaesthesia 16 (17%). Two deaths were associated with sedation and one with epidural anaesthesia. The percentage of deaths caused by spinal anaesthesia increased in this triennium to 79%. Again, two thirds of these deaths resulted from poor treatment of well- recognised complications of spinal anaesthesia (hypotension and high motor block). The most common cause of death following general anaesthesia was difficult or failed intubation, which occurred in 50% of cases. Lack of basic skills in anaesthesia, including assessment and resuscitation, were identified. As in previous triennia, most anaesthesia- related deaths occurred at level 1 hospitals (70%). This reflects the need for skilled qualified anaesthetic care at these hospitals.