Saving Mothers’ Lives: Reviewing maternal deaths to make motherhood safer: 2006–2008

Abstract

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.

Progression from severe sepsis in pregnancy to death: a UK population‐based case‐control analysis

“…Immunosuppression is known to make women more susceptible to severe infection1, 2, 34, 35 and anaemia has been increasingly highlighted as a potential risk factor for severe obstetric complications 9, 13, 31. However, anaemia can be a risk factor, outcome or confounding variable for sepsis.…”

“…The most recent confidential enquiry into maternal deaths has shown that in the UK, the rate of maternal death from genital tract sepsis has decreased substantially from 1.13 to 0.50 deaths per 100 000 maternities (2006–2008 to 2010–2012) 1, 2. However, this promising trend obscures two main issues.…”

Intervention or interference? The need for expectant care throughout normal labour

“…The fifth woman had a concealed pregnancy and laboured and died alone at home. 22 So, none of these women fall into the category of 'normal, healthy women with normal haemoglobins who are at low risk to haemorrhage.' It would thus be fair to say that PPH is not a major cause of maternal mortality among low-risk women cared for by skilled clinicians in high income countries, and that there is no reason why such women should not be cared for expectantly in the third stage.…”

A randomised controlled trial and economic evaluation of intraoperative cell salvage during caesarean section in women at risk of haemorrhage: the SALVO (cell SALVage in Obstetrics) trial

“…1 Life-threatening blood loss is the primary indication for 95.6% of emergency hysterectomies in labour. 2 Haemorrhage is the most common cause for maternal critical care admission [3][4][5] and places a profound health burden on the childbearing population during an important life event.…”