A report into maternal deaths in the UK published on 9 December 2014 shows that the number of women dying during pregnancy, childbirth or within a year of giving birth has fallen, but reveals that as many as half of maternal deaths might be prevented with improvements in care.
Maternal deaths have dropped from 11 per 100,000 women giving birth in 2006–08 to 10 per 100,000 women giving birth in 2010–12, according to a national report by MBRRACE-UK, a team of academics, clinicians and charity representatives including Sands. The report was launched at the Royal College of Obstetricians and Gynaecologists to an audience of around 300 health professionals including Dr Dan Poulter, the Undersecretary of State for Health.
There are around 100 maternal deaths in the UK every year. The report examined all 321 cases of women in Britain who died during their pregnancy or within 6 weeks of the end of their pregnancy in the four years covered by the report, from either direct (related to the pregnancy or birth) or indirect causes. It also examined the deaths of the 419 women who died after six weeks but within a year of giving birth during that period.
The decrease in maternal deaths is the result of a fall in deaths due to pregnancy-related complications such as eclampsia, blood loss or blood clots and this fall continues a 10-year trend.
The number of deaths from indirect causes, including pre-existing medical or mental conditions, has however not fallen in the past ten years. Two thirds of the women died from medical conditions such as heart disease, neurological conditions (such as epilepsy) or mental health problems which were either not related to the pregnancy or exacerbated by the pregnancy.
Three out of four women who died had pre-existing medical and mental health problems before they became pregnant. The report says that women with pre-existing conditions need better pre-pregnancy advice as well as joint specialist and maternity care through pregnancy and birth.
Confidential enquiries – when cases are reviewed anonymously by a panel of experts in order to grade the care women have received - carried out into 203 of the deaths indicated that improvements in care in half of the cases may have saved a woman’s life.
Sepsis (whole body infection) currently kills around one in four women either during pregnancy or after childbirth. Experts looked closely at the care of the 83 women who died over the four year period from sepsis as well as those who survived an episode of septic shock. It’s crucial, says the report, that clinicians ‘Think Sepsis’ and are aware of the signs. Women with sepsis need early diagnosis, rapid antibiotics and to be seen by senior doctors.
Raising awareness among women of the symptoms of sepsis may also encourage women to seek medical help sooner. Those attending the RCOG launch heard movingly from Samantha Cousins, a mum who spent three months in intensive care after developing sepsis shortly after giving birth. Despite daily calls to her maternity unit after giving birth, she wasn’t readmitted to hospital until six days later by which time she had become seriously ill. Prompt treatment and action in cases of sepsis, emphasised co-author of the report Professor Marian Knight, can make the difference between life and death.
Another vital message in the report is the significance of flu. Over the four year period covered by the report 36 women died of flu. The report found that two thirds of these deaths occurred after the new policy to offer the flu vaccination routinely to pregnant women and these deaths might therefore have been avoided. Uptake for the vaccination during pregnancy, however, is only at around 25%, partly because women are not taking up the chance to have it. Having the ‘flu vaccination also reduces the risk of stillbirth which occurs in 1 in 200 pregnancies.
As Dr Poulter acknowledged in his opening address, perinatal mental health is also a key area of concern for all clinicians. Almost one in four of the ‘late maternal deaths’ (women who die beyond six weeks from giving birth and up to a year after the birth) were due to suicide. Perinatal psychosis will be a major theme in the Maternal Report currently being prepared for publication in December 2015.
More than two out of three women who died did not receive the recommended amount of antenatal care. While this may or may not have contributed to their deaths, the message from the report is that all women should receive the right antenatal care for them.
Neal Long, Sands Chief Executive commented: “We are pleased to be part of MBRRACE-UK and this vital work, ensuring that no maternal death goes unnoticed. While the chances of a woman dying in and around childbirth in the United Kingdom are smaller than ever – 1 in every 10,000 – it remains the case that many of these deaths could be avoided. There are important lessons to be learnt from the report, not least that improvements in awareness and the care women receive could save lives.”
The report, called ‘Saving Lives, Improving Mothers’ Care: Lessons learned to inform future maternity care from the 2009-2012 UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity’, is available here.
The enquiry was carried out through the MBRRACE-UK programme (Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK) which is led from the National Perinatal Epidemiology Unit, Oxford University.
This is the 60th consecutive year in which the care of women who died during or after pregnancy has undergone detailed review in the UK. The aim is to learn what lessons are possible for improving care and recommend changes to reduce deaths in the future.
For the first time, the report includes the care of women in Ireland, and the care of women who survived severe illness and complications around the time of birth.