Saving Mothers' Lives: - Public Health Agency for Northern Ireland

obstetricians and anaesthetists routinely working on labour wards already know that anticipating or
dealing with maternal haemorrhage occupies a considerable proportion of their skill and time. The
management of severe haemorrhage can not only provoke extreme anxiety for the woman and her
relatives, but also causes a great deal of worry and stress for the attendant staff.
• In global terms, haemorrhage remains one of the most important causes of maternal mortality 3
and accounts for 11% of all maternal deaths. The World Health Organisation (WHO) estimates a
1% case fatality rate for the 14 million annual cases of obstetric haemorrhage 4 . As a conservative
estimate, some 140,000 deaths each year could be prevented if the women themselves had been
given an understanding of the possible warning signs of bleeding, the knowledge and ability to
seek skilled maternity care, at least at delivery, and had access to functioning emergency obstetric
services.
Table 4.1 shows the details of the 17 women who died directly from obstetric haemorrhage this triennium,
including two deaths from genital tract trauma associated with severe bleeding and one from a ruptured
uterus, causes of mortality which, in the past, merited a Chapter of their own. For the purposes of
comparison with previous triennia, these three women have been omitted from the rates from haemorrhage
shown in Table 4.1. They are shown in a separate column, together with the corresponding numbers from
previous triennia. Haemorrhage was also a complicating factor in nine other maternal deaths which are
counted and discussed in other Chapters, including amniotic fl uid embolism, sepsis and pre-eclampsia.
Table 4.1
Direct deaths by type of obstetric haemorrhage and mortality rate per 100,000 maternities;
United Kingdom: 1985-2005.
Triennium Placental
abruption
Cause of Haemorrhage
Placenta
praevia
Postpartum
haemorrhage
Total Genital
tract
trauma*
Overall total
Number Number Number Number Rate 95 per cent CI Number Number Rate
1985-87 4 0 6 10 0.44 0.24 0.81 6 16 0.71
1985-87 6 5 11 22 0.93 0.62 1.41 3 25 1.06
1991-93 3 4 8 15 0.65 0.39 1.07 4 19 0.82
1994-96 4 3 5 12 0.55 0.31 0.95 5 17 0.77
1997-99 3 3 1 7 0.33 0.16 0.68 2 9 0.42
2000-02 3 4 10 17 0.85 0.53 1.36 1 18 0.90
2003-05 2 3 9 14 0.66 0.39 1.11 3 17 0.80
* Includes ruptured uterus. These deaths were discussed in a separate Chapter in previous reports.
The women who died
The ages of the mothers who died from haemorrhage ranged between 25 and 44 years with a median age
of 33 years. Five were primiparous, another fi ve had one previous child and two had at least fi ve children
each. Six of these women had a body mass index (BMI) of greater than 30 and two were morbidly obese
with a BMI over 35. Eleven were delivered by caesarean section.
79