{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,15]],"date-time":"2026-01-15T05:27:59Z","timestamp":1768454879157,"version":"3.49.0"},"reference-count":36,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2023,6,21]],"date-time":"2023-06-21T00:00:00Z","timestamp":1687305600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Tropical Med Int Health"],"published-print":{"date-parts":[[2023,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>To describe the incidence and outcomes of pulmonary oedema in women with severe maternal outcome during childbirth and identify possible modifiable factors through audit.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>All women with severe maternal outcome (maternal deaths or near misses) who were referred to Tygerberg referral hospital from health facilities in Metro East district, South Africa, during 2014\u20132015 were included. Women with severe maternal outcome and pulmonary oedema during pregnancy or childbirth were evaluated using three types of critical incident audit: criterion\u2010based case review by one consultant gynaecologist, monodisciplinary critical incident audit by a team of gynaecologists, multidisciplinary audit with expert review from anaesthesiologists and cardiologists.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 32,161 pregnant women who gave birth in the study period, 399 (1.2%) women had severe maternal outcome and 72\/399 (18.1%) had pulmonary oedema with a case fatality rate of 5.6% (4\/72). Critical incident audit demonstrated that pre\u2010eclampsia\/HELLP\u2010syndrome and chronic hypertension were the main conditions underlying pulmonary oedema (44\/72, 61.1%). Administration of volumes of intravenous fluids in already sick women, undiagnosed underlying cardiac illness, administration of magnesium sulphate as part of pre\u2010eclampsia management and oxytocin for augmentation of labour were identified as possible contributors to the pathophysiology of pulmonary oedema. Women\u2010related factors (improved antenatal care attendance) and health care\u2010related factors (earlier diagnosis and management) would potentially have improved maternal outcome.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Although pulmonary oedema in pregnancy is rare, among women with severe maternal outcome a considerable proportion had pulmonary oedema (18.1%). Audit identified options for prevention of pulmonary oedema and improved outcome. These included early detection and management of preeclampsia with close monitoring of fluid intake and cardiac evaluation in case of suspected pulmonary oedema. Therefore, a multidisciplinary clinical approach is recommended.<\/jats:p><\/jats:sec>","DOI":"10.1111\/tmi.13905","type":"journal-article","created":{"date-parts":[[2023,6,21]],"date-time":"2023-06-21T09:19:07Z","timestamp":1687339147000},"page":"677-687","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Pulmonary oedema in the course of severe maternal outcome in South Africa: A cohort study combined with clinical audit"],"prefix":"10.1111","volume":"28","author":[{"given":"Anke","family":"Heitkamp","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynaecology Stellenbosch University and Tygerberg Academic Hospital  Cape Town South Africa"},{"name":"Department of Obstetrics and Gynaecology, Amsterdam UMC Vrije Universiteit Amsterdam and Research Institute Amsterdam Reproduction &amp; Development  Amsterdam The 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