Maternal death and postpartum hemorrhage in sub-Saharan Africa: insights from autopsies in Mozambique

• Maternal autopsies revealed that postpartum hemorrhage remains the main cause of death at major university hospital in SSA. • Modernized multidisciplinary collaborations involving hematology appear critical to reduce MM from postpartum hemorrhage. Maternal mortality (MM) in sub-Saharan Africa (SSA) is ∼100-fold higher compared to developed countries. Postpartum hemorrhage (PPH) is estimated to cause 30% to 50% of deaths. To determine the direct contribution of PPH to MM and provide clinical context, autopsy reports of pregnant women who died at Hospital Central de Maputo (the largest university hospital in Mozambique) were analyzed. Extracted data included age, labs, and vitals on admission, delivery characteristics, human immunodeficiency viral status, and causes of death. PPH occurred in 22/56 women (39.3%). PPH was the direct cause of death for 17/56 (30.3%) followed by hypertensive diseases (28.6%), together causing ∼2/3rd of deaths. Women with labs on admission who later experienced PPH had lower median hemoglobin (8.6 g/dL vs 10 g/dL; P = .059) and platelets (127.5 × 10 9 vs 187 × 10 9 ; P = .040) compared to those who did not. Most bleeding women had not received blood products and/or tranexamic acid. This study revealed that despite best World Health Organization efforts to reduce PPH-related MM, PPH is still a highly prevalent cause of MM. This is tragic since PPH is a preventable condition, calling for multidisciplinary PPH prevention/intervention protocols involving Hematology and Transfusion Medicine to minimize MM where applicable in SSA.