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

118
9 Cardiac disease
Table 9.1
Indirect maternal deaths from congenital and acquired cardiac disease and rates per 100,000 maternities;
United Kingdom: 1985-2005.
Triennium Congenital Acquired Total Rate 95 per cent CI
Ischaemic Other
n (%) n (%) n (%) n (%)
1985-1987 10 (43) 9 (39) 4 (17) 23 (100) 1.01 0.68 1.52
1988-1990 9 (50) 5 (28) 4 (22) 18 (100) 0.76 0.48 1.21
1991-1993 9 (24) 8 (22) 20 (54) 37 (100) 1.60 1.16 2.20
1994-1996 10 (26) 6 (15) 23 (59) 39 (100) 1.77 1.30 2.43
1997-1999 10 (29) 5 (14) 20 (57) 35 (100) 1.65 1.19 2.29
2000-2002 9 (20) 8 (18) 27 (61) 44 (100) 2.20 1.64 2.96
2003-2005 4 (8) 16 (33) 28* (58) 48 (100) 2.27 1.67 2.96
* Includes one case which was not assessed.
The leading cardiac causes of maternal death are now myocardial infarction, mostly related to ischaemic
heart disease, and dissection of the thoracic aorta. Maternal deaths from pulmonary hypertension and from
congenital heart disease were less common than in previous triennia. Rheumatic mitral stenosis has reemerged
as a cause of maternal death.
Both the relative and absolute numbers of deaths from myocardial infarction in pregnant or recently
delivered women are increasing. Although not directly or indirectly related to pregnancy, these Coincidental
cardiac deaths nevertheless contain important public health lessons by demonstrating that the large
increase in the proportion of women dying of myocardial infarction is due to ischaemic heart disease which
tends to be associated with avoidable or remediable lifestyle factors. For example, 29 of the 45 maternal
deaths from cardiac disease and for whom a Body Mass Index (BMI) was available, occurred in women
who were overweight or obese. Of these women, 14 were overweight with BMI over 25 and 15 were obese
with a BMI over 30. Nine of these 15 women were morbidly obese with a BMI over 35, including fi ve with a
BMI greater than 40.
All the women who died from peripartum cardiomyopathy in this triennium are counted as Late deaths
as they died some time after delivery, although most presented sooner than this. These deaths will
continue to be assessed by this Enquiry. Indeed, in the opinion of the assessors, deaths from peripartum
cardiomyopathy would not have occurred if the women had not been pregnant and should, in international
and national terms, be classifi ed as Direct deaths in future.
The assessors considered that some degree of sub-standard care was present in 23 or nearly half of
the 47 cases. As with preceding Reports, a lower proportion, 36%, of women who died from Late cardiac
causes had any degree of sub-standard care.
Table 9.2 shows the overall numbers of cardiac maternal deaths in 2003-05 which were assessed,
subdivided by major cause of death.