Experiences with maternal and perinatal death reviews in the <scp>UK</scp>—the <scp>MBRRACE</scp>‐<scp>UK</scp> programme

Kurinczuk, JJ; Draper, Elizabeth S; Field, David; Bevan, Charlotte L.; Brocklehurst, Peter; Gray, Richard; Kenyon, Sara; Manktelow, Bradley N; Neilson, JP; Redshaw, Maggie; Scott, Janet; Shakespeare, Judy; Smith, Lucy; Knight, Marian

doi:10.1111/1471-0528.12820

Cited by 69 publications

(56 citation statements)

References 4 publications

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“…2,147 Deaths of women during or after pregnancy are identified through a variety of sources, the majority being notified to the MBRRACE-UK office directly from the unit in which the maternal death occurred. Other sources include coroners/procurators fiscal or pathologists, local supervising authority midwifery officers, members of the public and inquest reports from the media.…”

Section: Data Sourcesmentioning

confidence: 99%

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Beyond maternal death: improving the quality of maternal care through national studies of ‘near-miss’ maternal morbidity

Knight

Acosta

Brocklehurst

et al. 2016

Programme Grants Appl Res

101

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BackgroundStudies of maternal mortality have been shown to result in important improvements to women’s health. It is now recognised that in countries such as the UK, where maternal deaths are rare, the study of near-miss severe maternal morbidity provides additional information to aid disease prevention, treatment and service provision.ObjectivesTo (1) estimate the incidence of specific near-miss morbidities; (2) assess the contribution of existing risk factors to incidence; (3) describe different interventions and their impact on outcomes and costs; (4) identify any groups in which outcomes differ; (5) investigate factors associated with maternal death; (6) compare an external confidential enquiry or a local review approach for investigating quality of care for affected women; and (7) assess the longer-term impacts.MethodsMixed quantitative and qualitative methods including primary national observational studies, database analyses, surveys and case studies overseen by a user advisory group.SettingMaternity units in all four countries of the UK.ParticipantsWomen with near-miss maternal morbidities, their partners and comparison women without severe morbidity.Main outcome measuresThe incidence, risk factors, management and outcomes of uterine rupture, placenta accreta, haemolysis, elevated liver enzymes and low platelets (HELLP) syndrome, severe sepsis, amniotic fluid embolism and pregnancy at advanced maternal age (≥ 48 years at completion of pregnancy); factors associated with progression from severe morbidity to death; associations between severe maternal morbidity and ethnicity and socioeconomic status; lessons for care identified by local and external review; economic evaluation of interventions for management of postpartum haemorrhage (PPH); women’s experiences of near-miss maternal morbidity; long-term outcomes; and models of maternity care commissioned through experience-led and standard approaches.ResultsWomen and their partners reported long-term impacts of near-miss maternal morbidities on their physical and mental health. Older maternal age and caesarean delivery are associated with severe maternal morbidity in both current and future pregnancies. Antibiotic prescription for pregnant or postpartum women with suspected infection does not necessarily prevent progression to severe sepsis, which may be rapidly progressive. Delay in delivery, of up to 48 hours, may be safely undertaken in women with HELLP syndrome in whom there is no fetal compromise. Uterine compression sutures are a cost-effective second-line therapy for PPH. Medical comorbidities are associated with a fivefold increase in the odds of maternal death from direct pregnancy complications. External reviews identified more specific clinical messages for care than local reviews. Experience-led commissioning may be used as a way to commission maternity services.LimitationsThis programme used observational studies, some with limited sample size, and the possibility of uncontrolled confounding cannot be excluded.ConclusionsImplementation of the findings of this research could prevent both future severe pregnancy complications as well as improving the outcome of pregnancy for women. One of the clearest findings relates to the population of women with other medical and mental health problems in pregnancy and their risk of severe morbidity. Further research into models of pre-pregnancy, pregnancy and postnatal care is clearly needed.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.

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Section: Data Sourcesmentioning

confidence: 99%

“…2,147 Two obstetricians, a midwife and two anaesthetists assessed the care of each woman. Five reviewers thus examined each woman's care.…”

Section: Conditions Eliciting Local Reviewsmentioning

confidence: 99%

Beyond maternal death: improving the quality of maternal care through national studies of ‘near-miss’ maternal morbidity

Knight

Acosta

Brocklehurst

et al. 2016

Programme Grants Appl Res

101

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“…Maternal and perinatal death audits or review show that in many cases health-care providers failed to recognize and manage complications in a timely and effective manner, and this is one of the contributors to poor-quality or substandard care [30,31].…”

Section: Emergency Obstetric Carementioning

confidence: 99%

Making It Happen: Training health-care providers in emergency obstetric and newborn care

Ameh

Broek

2015

Best Practice & Research Clinical Obstetrics & Gynaecol

100

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An estimated 289,000 maternal deaths, 2.6 million stillbirths and 2.4 million newborn deaths occur globally each year, with the majority occurring around the time of childbirth. The medical and surgical interventions to prevent this loss of life are known, and most maternal and newborn deaths are in principle preventable. There is a need to build the capacity of health-care providers to recognize and manage complications during pregnancy, childbirth and the post-partum period. Skills-and-drills competency-based training in skilled birth attendance, emergency obstetric care and early newborn care (EmONC) is an approach that is successful in improving knowledge and skills. There is emerging evidence of this resulting in improved availability and quality of care. To evaluate the effectiveness of EmONC training, operational research using an adapted Kirkpatrick framework and a theory of change approach is needed. The Making It Happen programme is an example of this.

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“…UKOSS gained ethical approval from the London Multicentre Research Ethics Committee (study reference 04/MRE02/45). In England and Wales, MBRRACE‐UK has approval from the Secretary of State for Health, attained by request to the Confidentiality Advisory Group of the Health Research Authority (it was formally known as National Information Governance Board) (ECC 5‐05 (f)/2012) 13. Permissions were gained from the respective bodies within Scotland and Northern Ireland.…”

Section: Disclosure Of Interestsmentioning

confidence: 99%

Factors associated with maternal mortality at advanced maternal age: a population‐based case–control study

McCall

Nair

Knight

2016

BJOG

Self Cite

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ObjectiveThis study aimed to examine the factors associated with maternal mortality among women aged ≥35 years.DesignUnmatched population based case–control study.SettingUnited Kingdom.PopulationBetween 2009 and 2012, 105 cases of maternal deaths aged ≥35 years were extracted from the surveillance database of the MBRRACE‐UK confidential enquiries into maternal deaths in the UK. In addition, 766 controls aged ≥35 years were identified from the UK Obstetric Surveillance System (2005–2012).MethodsRisk factors known to be associated with maternal mortality and morbidity and for which data were available were examined for their association with maternal mortality among women ≥35 years using logistic regression analysis.Main outcome measuresOdds ratios and 95% confidence intervals associated with maternal death.ResultsFive factors were found to be significantly associated with increased odds of death among women aged ≥35 years: smoking during pregnancy (adjusted odds ratio (aOR) 2.06, 95% CI 1.13–3.75), inadequate use of antenatal care (aOR 23.62, 95% CI 8.79–63.45), medical co‐morbidities (aOR 5.92, 95% CI 3.56–9.86) and previous pregnancy problems (aOR 2.06, 95% CI 1.23–3.45). The odds associated with death increased by 12% per year increase in age (aOR 1.12, 95% CI 1.02–1.22).ConclusionAge was associated with maternal mortality even after adjusting for other known risk factors. Importantly, this study showed an association between maternal mortality and smoking among women aged 35 years or older. It emphasises the importance of public health action to reduce smoking levels and address trends in rising maternal age.Tweetable abstractSmoking is a risk factor for maternal death for those aged over 35 years.

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Experiences with maternal and perinatal death reviews in the UK—the MBRRACE‐UK programme

Cited by 69 publications

References 4 publications

Beyond maternal death: improving the quality of maternal care through national studies of ‘near-miss’ maternal morbidity

Beyond maternal death: improving the quality of maternal care through national studies of ‘near-miss’ maternal morbidity

Making It Happen: Training health-care providers in emergency obstetric and newborn care

Factors associated with maternal mortality at advanced maternal age: a population‐based case–control study

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