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

The women who died
The ages of the women who died ranged between 18-40 years with a median age of 31. In contrast to the
last Report, all but two mothers were White. Most women were in long term stable relationships and a few
were health care workers.
Sub-standard care
As in previous years, the major challenge is to reduce the number of deaths from ectopic pregnancy,
especially those associated with sub-standard care. Overall, 11 of the 14 deaths counted in this Chapter
were assessed as having sub-standard care. Seven of the ten deaths from ectopic pregnancy were
associated with sub-standard care, as were all the deaths from other causes counted in this Chapter.
Ectopic pregnancy
The maternal death rates from ectopic pregnancy for this and previous triennia are shown in Table 6.2.
Table 6.2
Numbers of deaths from ectopic pregnancies and rates per 100,000 estimated ectopic pregnancies;
England and Wales 1988-1990 and United Kingdom: 1991-2005.
Triennium Total
estimated
pregnancies
England and Wales
Total
estimated
ectopic
pregnancies
Ectopic pregnancies
per 1,000 pregnancies
Deaths from
ectopic
pregnancies
Death rate per 100,000
estimated ectopic
pregnancies
Number Number Rate 95 per cent CI Number Rate 95 per cent CI
1988-90 2,880,814 24,775 8.6 8.5 8.7 15 0.52 0.31 0.86
United Kingdom
1991-93 3,141,667 30,160 9.6 9.5 9.7 9 0.29 0.15 0.55
1994-96 2,917,391 33,550 11.5 11.4 11.6 12 0.41 0.24 0.72
1997-99 2,878,018 31,946 11.1 11.0 11.2 13 0.45 0.26 0.77
2000-02 2,736,364 30,100 11.0 10.9 11.1 11 0.40 0.22 0.72
2003-05 2,891,892 32,100 11.1 10.9 11.1 10 0.35 0.19 0.64
Ten women died from ruptured ectopic pregnancies during the period of this Report. Another woman,
whose death is counted in the anaesthetic Chapter (Chapter 8), died of the consequences of the
anaesthetic she received for treatment of an ectopic pregnancy. Among the ten deaths counted in this
Chapter was one corneal (interstitial) pregnancy. Another woman had a heterotopic pregnancy (combined
intra- and extra-uterine pregnancies). She presented with diarrhoea and vomiting, as did three other
women with (non-heterotopic) ectopic pregnancies in whom misdiagnosis occurred. Recent Reports
have repeatedly emphasised the importance of diarrhoea and vomiting as a possible, atypical clinical
presentation of ectopic pregnancy:
A woman who had diarrhoea and vomiting also had vaginal bleeding, fainting and severe
abdominal pain. She was known to be pregnant and was diagnosed as having gastroenteritis by
a very junior gynaecologist in an Emergency Department (ED), and discharged. She returned
to the ED the following day with increased pain, having collapsed at home. She was found to
be hypotensive and tachycardic by the nursing staff, given a very large amount of intravenous
93