• R C Pattinson, T M A G Hlongwane, and V Vannevel.
• Department of Obstetrics and Gynaecology, School of Medicine, Faculty of Health Sciences, and Research Centre for Maternal, Fetal, Newborn and Child Health Care Strategies, University of Pretoria, and Maternal and Infant Health Care Strategies Research Unit, South African Medical Research Council, Pretoria, South Africa. robert.pattinson@up.ac.za.
• S. Afr. Med. J. 2019 Dec 5; 109 (11b): 15-19.

AbstractThe major causes of maternal and perinatal deaths have been well described in South Africa. These causes are related to HIV infection, placental insufficiency and intrapartum asphyxia. The health system failures that most commonly lead to preventable mortality are related to managing hypertensive disorders in pregnancy (HDP), detecting fetal growth restriction antenatally and managing labour effectively by providing caesarean delivery to those who need it and avoiding it in those who do not. Improving antenatal and intrapartum care are vital aspects in efforts to improve survival, but to achieve this the following challenges need to be overcome: managing the increased antenatal care contacts needed to detect HDP creating a next level of expertise, and access for women to high-risk care creating the environment for respectful care and companionship in labour managing labour as physiologically as possible detecting and managing placental insufficiency.  This article provides some exciting solutions to these health system barriers.

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