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.
Since 2003, a continuous audit of severe maternal morbidity in Scotland has been conducted, collecting data on consistently defined events in all the consultant-led maternity units within Scotland. This review summarizes the methodology of the audit and describes some of the main results accumulated in the 10 years audited [2003-2012 (The 2012 Scottish Confidential Audit of Severe Maternal Morbidity report is yet to be published. This article refers to extracts from 2012 data where available, but on other occasions refers to data from 2003 to 2011.)]. Although most causes of severe maternal morbidity have decreased during the audit, major obstetric haemorrhage, the most common cause of severe maternal morbidity, has increased. Some key findings are as follows: admission to an ICU is required for 1 woman in every 700 births; major obstetric haemorrhage is experienced by 1 in 172 women; cases of eclampsia have decreased during the audit; there were deficiencies in antenatal risk identification and action planning; and the direct involvement of consultant obstetricians and anaesthetists in the care of women was below those recommended by the guidelines. The audit has demonstrated changes in clinical practice and in adherence to clinical guidelines over time. The information has been used to inform clinical practice within the Scottish maternity units.
The detection of women with obstetric high-risk factors is now recognized as a major aim of antenatal care, especially in developing countries, and those factors most important in Papua New Guinea obstetric practice have been identified by a study of maternal deaths. The present study aimed to assess the value of the detection of these factors by comparing the outcomes of pregnancies with and without high risk factors. Home, health centre and hospital deliveries in two districts of Enga Province in the Papua New Guinea Highlands were studied. Of the total 2225 deliveries, 74% took place at home, the proximity of a health centre appearing to be a major determinant in the choice between home or supervised institutional delivery. Fifty-three per cent of women had at least one high risk factor, and 92% of these factors were historical. Eighty-two per cent of women had an uncomplicated normal delivery, while post-partum haemorrhage was the commonest complication, occurring in 7.6% of deliveries. This complication also caused all 4 maternal deaths. There was good correlation between delivery complications and the presence of high-risk factors, 70% of complications occurring in at-risk pregnancies. It is concluded that the detection of high-risk factors in pregnancy is very worthwhile. But, as a separate study has shown, the rate of detection antenatally could be improved, and until more health centres are constructed it will probably prove difficult to persuade all those at high risk to deliver under supervision.
The use of the WHO partograph in the management of breech labor reduces prolonged labor and (among multigravida) Cesarean sections and improves fetal outcome. In this study, however, Cesarean section was a safer method of delivery for the baby, regardless of use of the partograph.
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