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Joint RCOG and BMFMS statement on MBRRACE-UK report into maternal deaths and morbidity

News 9 December 2014

Today (9 December) MBRRACE-UK, led by the National Perinatal Epidemiology Unit at the University of Oxford, publish their report into maternal mortality and morbidity.

The report, 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, will be launched at the Royal College of Obstetricians and Gynaecologists (RCOG).

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.

A maternal death is defined as the death of a woman while pregnant or within 42 days of the end of the pregnancy from any cause related to or aggravated by the pregnancy or its management and not from accidental causes (WHO 2010).

The report shows an overall fall in maternal deaths from 11 per 100,000 in 2006-08 to 10 per 100,000 in 2010-12, primarily due to a reduction in the direct causes attributable to pregnancy. Two thirds of the mothers who died were due to indirect causes of death (those due to co-existing medical and psychiatric conditions) which have remained stable for the last 10 years.

The report highlights the relation between poor outcomes and women not accessing antenatal care in a timely manner, and women with complex medical and mental health problems not receiving multidisciplinary pre-pregnancy advice.

The RCOG and British Maternal & Fetal Medicine Society (BMFMS) are concerned by these findings. Appropriate pre-pregnancy counselling, early booking and timely referral for specialist multidisciplinary antenatal care are all vital to make an impact on indirect maternal mortality. This will require greater interaction between primary and secondary care and funding to support its development.

It is also important that all healthcare professionals have a recognised network of care that they can contact if they encounter a woman with symptoms requiring extra input. This includes access to obstetric physicians and perinatal psychiatrists.

The report also spans the period of the influenza A/H1N1 pandemic (swine flu), which severely affected pregnant women.

Professor Alan Cameron, Vice President of Clinical Quality for the Royal College of Obstetricians and Gynaecologists (RCOG), said:

“The report shows a welcome decrease in the overall rate of maternal deaths across the UK and Ireland in the context of a rising birth rate and more complex pregnancies. From these figures, we stress that maternal deaths in the UK are rare.

“However more needs to be done to address maternal deaths from indirect causes, both from medical and mental health conditions, as deaths from these causes have not decreased over the last 10 years.

“Between 2006-08 and this new report, the maternal mortality rate from genital tract sepsis more than halved – this is very welcome. Sepsis can develop very quickly and it is essential that the symptoms are recognised as early as possible. Healthcare professionals need to act quickly and remain vigilant to keep sepsis rates down. As a result of findings from the previous Confidential Enquiry, the RCOG produced specific guidelines on bacterial sepsis in pregnancy and following pregnancy in 2012.

“Furthermore, the report highlights the importance of pregnant women having the flu vaccination when it is offered to them. This prevents poor outcomes for both mother and baby. Much work has been done to provide the flu vaccine to pregnant women and it is vital that they and the health professionals involved in maternity care have the vaccination to protect themselves against seasonal influenza.

“Much has been achieved but more can be done to improve the care of future mothers.”

Mr Tim Overton, President of the BMFMS said:

“MBRRACE-UK is to be congratulated for producing such a comprehensive Confidential Enquiry. It is gratifying to see that there has been, yet again, a drop in the overall maternal mortality rate.

“It is clear, however, that the challenge is now to reduce deaths from indirect causes which have remained static for the last 10 years. Nearly three-quarters of women who died in this triennium had a co-existing medical complication.

“Indirect deaths will only be reduced with greater integration between primary and secondary care. Women with significant medical and psychiatric conditions, need to be assessed by multidisciplinary teams enabling risk-stratification before becoming pregnant, and then referred early in pregnancy to the same team allowing timely and appropriate delivery of antenatal care. This needs to be underpinned by robust and appropriately funded pathways delivered by obstetricians, physicians and midwives working as a team with appropriate specialist training.

“Over the last 10 years the RCOG and BMFMS have worked together to develop advanced training programmes in complex medical conditions which affect pregnancy and the implementation and delivery of this training now needs to be strengthened.”

Ends

For further information, please contact the RCOG Media and PR team on +44 20 7772 6300 or email pressoffice@rcog.org.uk

The RCOG guidelines on sepsis can be found here.

Key messages from the UK and Ireland Confidential Enquires into maternal death and morbidity discussed in new TOG review.