Authors Abstract

The case presented by Davies and Hofmeyr illustrates the consequences of systems failure to patient care.1 A patient with severe preeclampsia and an uncorrected cardiac lesion (in this case, Tetralogy of Fallot [TOF]) should be managed in a tertiary/quaternary setting, by a multidisciplinary team including a specialist obstetrician, anaesthesiologist, and cardiologist. The underlying cardiac condition should have resulted in early antenatal discussion regarding the threat of pregnancy to maternal life, including whether termination of pregnancy should be recommended. This complex decision was precluded by late booking of the pregnancy. The patient subsequently missed a high-risk clinic appointment, further preventing timely access to the specialised care she required. This is regrettably a common occurrence in South Africa. The NCCEMD report (2020–2022) showed that 57% of maternal deaths were deemed potentially preventable during this triennium.2 The major causes of death included obstetric haemorrhage (16%), hypertensive disorders of pregnancy (15%), and medical and surgical disorders (14%).2 It should be self-evident that when these conditions coexist, mortality risk increases significantly. In Africa, while the complication rate following caesarean delivery is 2–3 times higher than in high-income countries, the risk of dying is 50 times higher.3

Author Biographies DG Bishop, University of KwaZulu-Natal

Discipline of Anaesthesiology and Critical Care, School of Clinical Medicine, University of KwaZulu-Natal, South Africa

RA Dyer, University of Cape Town

Department of Anaesthesia and Perioperative Medicine, University of Cape Town, South Africa

M Crowther, University of Cape Town

Department of Anaesthesia and Perioperative Medicine, University of Cape Town, South Africa

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