{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T17:54:21Z","timestamp":1792000461364,"version":"4.4.0"},"reference-count":25,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T00:00:00Z","timestamp":1791936000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec016\">\n                    <jats:title\/>\n                    <jats:p>Maternal deaths on arrival remain one of the blind spots in maternal death surveillance and response programs. There are no policy and guideline addressing maternal deaths on arrival in South Africa. Main objective was to analyse maternal deaths on arrival at the health facilities in a South African district. All maternal deaths on arrival at the health facilities at the Ekurhuleni district over a period of five years and nine months (July 2014 to March 2020), were retrospectively reviewed. Analysis included maternal mortality ratio, demography, gestational age at booking, delivery and deaths, newborn outcome, causes and interval between hospital discharge and presenting as dead. Descriptive statistics (proportion, mean, standard deviation, median and interquartile range) and inferential statistics (Chi-square test, Fishers exact test and Students t test) comparing the women with known and unknown causes, are presented. Twenty-eight (5.72%) women out of the 489 maternal deaths were dead on arrival. The maternal mortality ratio was 7.65 maternal deaths per 100000 live births. Causes of deaths were inconclusive in 17 (60.71%). Among the known causes, the commonest (5, 45.45%) cause was haemorrhage. Median interval between discharge from hospital and presenting as dead was 2.5 days. Information on three delay model were unavailable. Delay two was mentioned for only one year where ambulance service was disrupted due to local protests against municipal services. Comparison between the known and unknown causes showed the regional hospitals had significantly higher numbers of known causes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec001\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Maternal deaths on arrival was an important contributor to maternal mortality in this study although poorly documented. Majority attended antenatal care and delivered at the hospitals raising a suspicion of early hospital discharge and failure to timely follow-up. A protocol and guideline, with a focus on postmortem examinations should be developed for management of maternal deaths on arrival.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0358988","type":"journal-article","created":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T17:29:28Z","timestamp":1791998968000},"page":"e0358988","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Maternal deaths on arrival: A 5-year retrospective study in a health district in South Africa"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1523-2555","authenticated-orcid":true,"given":"Jayati Kusari","family":"Basu","sequence":"first","affiliation":[{"name":"Obstetrics & Gynecology, Ekurhuleni District Clinical Specialist Team, Ekurhuleni Health District","place":["Germiston city, South Africa"],"department":["Department of Health"]},{"name":"University of the Witwatersrand","place":["Johannesburg, South Africa"],"department":["Department of Obstetrics and Gynecology, Faculty of Health Sciences"]},{"name":"South African Medical Research Council, University of Pretoria","place":["Pretoria, South Africa"],"department":["Maternal and Infant Health Care Strategies Research Unit"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aimee","family":"Stewart","sequence":"additional","affiliation":[{"name":"School of Therapeutic Sciences, University of the Witwatersrand","place":["Johannesburg, South Africa"],"department":["Physiotherapy Department, Faculty of Health Sciences"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lawrence","family":"Chauke","sequence":"additional","affiliation":[{"name":"University of the Witwatersrand","place":["Johannesburg, South Africa"],"department":["Department of Obstetrics and Gynecology, Faculty of Health Sciences"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,10,14]]},"reference":[{"key":"pone.0358988.ref001","unstructured":"WHO. Trends in maternal mortality estimates 2000 to 2023 Estimates by WHO, UNICEF, UNFPA, World Bank Group and UNDESA\/Population Division. 2025 Trends in Maternal Mortality 2000-2023: Estimates by WHO, UNICEF, UNFPA, World Bank Group and UNDESA\/Population Division [EN\/AR\/RU\/ZH] - World | ReliefWeb)."},{"key":"pone.0358988.ref002","unstructured":"UNICEF. Maternal mortality. Maternal mortality rates and statistics - UNICEF DATA. 2025."},{"key":"pone.0358988.ref003","doi-asserted-by":"crossref","first-page":"102572","DOI":"10.1016\/j.bpobgyn.2024.102572","article-title":"Improving access to emergency obstetric care in low- and middle-income countries","volume":"98","author":"L Chauke","year":"2025","journal-title":"Best Pract Res Clin Obstet Gynaecol"},{"key":"pone.0358988.ref004","unstructured":"WHO. World Health Day 2025 to spotlight women and babies\u2019 survival, urging solidarity at a critical moment for global health. A departmental update. 21st February 2025. 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