We welcome this report from the MBRRACE-UK team. It is gratifying to note that there has been a decrease in overall rates of maternal death, and that deaths from influenza and pre-eclampsia remain low. However, we are concerned that rates of indirect deaths remain high and that that two thirds of the women who died had medical co-morbidities. These include deaths from pre-existing conditions that are not directly related to pregnancy, such as mental health problems, epilepsy, heart disease or cancer.
It is particularly saddening that around one quarter of all maternal deaths between six weeks and a year after childbirth are related to mental health problems and one in seven of the women who died in this period committed suicide.
The authors suggest that in approximately 40% of cases it was thought that improvements in care may have made a difference to outcome. These will include adherence to guidelines and efficient referral to specialists in medical and mental health. The new NICE guideline on intrapartum care of high risk women should provide evidence based guidelines for the management of such women at the time of delivery.
As in previous years, the commonest causes of maternal death are cardiac disease and sepsis, both of which require multidisciplinary input in order to be treated effectively. Thromboembolism remains the leading cause of direct deaths, and it is important that the new RCOG guidelines for prevention and management of thromboembolism are followed.
This report allows us, as healthcare professionals, to learn from the unfortunate deaths that occur during and after pregnancy in the UK in order to make maternity services as safe as possible for women and their families in the future.
Dr David Richmond, President of RCOG, said: “Despite the overall decrease in the UK maternal death rate, it is clear that the challenge is now to reduce deaths from indirect causes which have remained static for the last 10 years.
“Greater integration between primary and secondary care is urgently needed to ensure that women with significant medical and psychiatric conditions are assessed before becoming pregnant and referred to specialist care in a timely manner to ensure that right support is provided throughout a woman’s pregnancy and beyond.
“No woman should suffer in silence and we encourage women and their families to speak to their GP, health visitor, midwife or obstetrician about any worrying signs and symptoms – there is help and support available.”
Mr Tim Overton, a consultant in fetal medicine and President of the BMFMS, said: “The major role of mental ill-health in deaths of women in the first year after giving birth emphasises the importance of early detection and effective treatment of mental ill health in such women. Although the red flag signs described in the report are helpful, the fact that 40% will have no access to specialist perinatal mental health services is deeply worrying.
“Many of the women who died were from vulnerable groups within society with complex social problems in addition to medical and mental health issues. It is important that care is effectively delivered to women with disadvantaged backgrounds.
“As always, this report highlights key areas for improvement. It is reassuring that resources have been pledged in the recently announced ambition by the Secretary of State for Health to reduce the rate of maternal deaths in England by 50% by 2030. The National Maternity Review, due to be published early next year, also presents a key opportunity for initiatives to address many of the issues raised in this report.”