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

10 Other Indirect deaths
Michael de Swiet
Indirect deaths: Specifi c recommendations
Women, especially teenage girls, with pre-existing, serious, medical conditions should have prepregnancy
counselling at every opportunity, even if they are not immediately seeking pregnancy. This
is especially the case if they seek assisted reproduction.
As part of ongoing education, all medical and midwifery practitioners, particularly specialists in acute
medical care, need some knowledge of the way in which common medical conditions interact with
pregnancy.
The early detection of severe illness in mothers remains a challenge and the use of modifi ed early
warning scoring systems, adapted for obstetric patients, one of the top ten key recommendations of
this Report, should help reduce the cases in which death has followed the late recognition of serious
illness.
All women with serious medical conditions must be referred by their midwives or General Practitioners
(GP) for specialist opinion as early in pregnancy as possible, even if this means breaking traditional
rules about referral pathways and timing.
Effective pathways must be established so that physicians and obstetricians can communicate properly
to treat pregnant women, both in acute illness and during regular antenatal care. The latter is best
managed in a combined medical obstetric antenatal clinic.
Maternity trusts and other health care providers must ensure that pregnant women with neurological
problems have early and ongoing access to combined neurology or medical/obstetric clinics to improve
the care of pregnant women with neurological problems.
The consultant obstetrician on call should be told about all sick pregnant women in hospital whether
they have a medical or an obstetric problem.
Maternity units should have on-site access to modern imaging facilities such as CT and MRI scans.
There is no place for “isolated” consultant led maternity units.
Multiple attendances and/or readmission without diagnosis are danger signs of serious undiagnosed
disease or a major health and social problem such as domestic abuse.
Epilepsy is dangerous because of the risk of sudden unexpected deaths in epilepsy (SUDEP). This risk
may not be greater in pregnancy than in the non-pregnant state but for a variety of reasons, epilepsy
may be more diffi cult to control in pregnancy thus increasing the risk of SUDEP. Mothers who stop
anticonvulsant therapy in pregnancy must be made aware of the risk of SUDEP.
Introduction
Indirect maternal deaths are defi ned as those deaths which occur during pregnancy or up to, and including,
42 days after the end of the pregnancy and which result from previously existing disease, or conditions
which develop during pregnancy which are aggravated by physiological effects of pregnancy. The
introductory section of this Report describes the international defi nitions and classifi cations of maternal
deaths in more detail.
Examples of Indirect deaths include those from epilepsy, diabetes, cerebral haemorrhage and HIV infection.
Cardiac causes of death are also classifi ed as Indirect but, such is their importance, they are discussed
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