Saving mothers’ lives

April 17, 2011 by  
Filed under Acute Med, All Updates, ICU, Resus

The eighth Report of the Confidential Enquiries into Maternal Deaths in the UK investigates the deaths of 261 women who died in the triennium 2006–08, from causes directly or indirectly related to pregnancy.

Direct deaths (from medical conditions that can only be the result of pregnancy) significantly decreased from 6.24 per 100 000 maternities in the last triennium to 4.67 per 100 000 maternities in this triennium (P = 0.02). This equates to 25 fewer direct maternal deaths over the triennium, and this decline is predominantly the result of reductions in deaths from thromboembolism, and to a lesser extent, haemorrhage. The case fatality rate for ectopic pregnancy has almost halved from an estimated rate of 31.2 per 100 000 estimated ectopic pregnancies in 2003–05 to 16.9 in this triennium.

Although Direct maternal deaths have decreased overall there has been a dramatic increase in deaths related to genital tract sepsis, particularly from community-acquired Group A streptococcal disease. The overall rate has increased from 0.85 deaths per 100 000 maternities in 2003–05 to 1.13 deaths in this triennium. Sepsis is now the commonest cause of Direct maternal deaths in the UK and this has prompted a Clinical Briefing from the Centre for Maternal and Child Enquiries (CMACE) alerting health professionals to the risks.

Indirect maternal death rates have remained largely unchanged since the last report. Cardiac disease remains the most common cause of Indirect maternal death: many of these women also had lifestyle-related risk factors for cardiac disease: obesity, smoking and increased maternal age.

The review revealed many of the deaths to be associated with substandard care, some of the challenges being:

  1. Improving clinical knowledge and skills.
  2. Identifying very sick women.
  3. Improving the quality of serious incident/serious untoward incident (SUI) reports.
  4. Improving senior support.
  5. Better management of higher risk women.
  6. Pre-pregnancy counselling.
  7. Better referrals.
  8. Improving communication or communication skills, including: poor or non-existent teamworking; inappropriate or overly short telephone consultations; poor sharing of information between health professionals, particularly the maternity care team and GPs; poor interpersonal skills.
ABSTRACT In the triennium 2006-2008, 261 women in the UK died directly or indirectly related to pregnancy. The overall maternal mortality rate was 11.39 per 100,000 maternities. Direct deaths decreased from 6.24 per 100,000 maternities in 2003-2005 to 4.67 per 100,000 maternities in 2006–2008 (p = 0.02). This decline is predominantly due to the reduction in deaths from thromboembolism and, to a lesser extent, haemorrhage. For the first time there has been a reduction in the inequalities gap, with a significant decrease in maternal mortality rates among those living in the most deprived areas and those in the lowest socio-economic group. Despite a decline in the overall UK maternal mortality rate, there has been an increase in deaths related to genital tract sepsis, particularly from community acquired Group A streptococcal disease. The mortality rate related to sepsis increased from 0.85 deaths per 100,000 maternities in 2003-2005 to 1.13 deaths in 2006-2008, and sepsis is now the most common cause of Direct maternal death. Cardiac disease is the most common cause of Indirect death; the Indirect maternal mortality rate has not changed significantly since 2003-2005. This Confidential Enquiry identified substandard care in 70% of Direct deaths and 55% of Indirect deaths. Many of the identified avoidable factors remain the same as those identified in previous Enquiries. Recommendations for improving care have been developed and are highlighted in this report. Implementing the Top ten recommendations should be prioritised in order to ensure the overall UK maternal mortality rate continues to decline.

Saving Mothers’ Lives: Reviewing maternal deaths to make motherhood safer: 2006-2008. The Eighth Report of the Confidential Enquiries into Maternal Deaths in the United Kingdom
BJOG. 2011 Mar;118 Suppl 1:1-203 (Full text available from CMACE site)

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