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

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132 10 Other Indirect deaths separately in Chapter 9 of this Report. The international defi nitions of maternal death exclude deaths from suicide due to perinatal mental illness and those from hormone dependent malignancies, both of which the UK assessors consider to be absolutely linked to the woman’s pregnancy. These causes of death also have their own separate Chapters in this Report. The remaining deaths due to Indirect causes are counted and discussed in this Chapter and are classifi ed as Other Indirect. However, in statistical terms, all these causes of Indirect deaths contribute to the overall UK Indirect mortality rate calculated for this Report. Summary of key fi ndings for 2003-05 Table 10.1 shows that in 2003-05, the deaths of 87 women who died from Other Indirect maternal causes were reported to this Enquiry, and Table 10.2 shows that their mortality rate was similar to that for 2000- 02. In some cases very few details were available to the assessors. In addition, 35 other deaths have contributed to the learning points in this Chapter but are counted in the Chapters relating to their main cause of death. The deaths of a number of women who died much later after the end of their pregnancy, Late deaths, were also assessed as part of the learning points although they are not counted here nor do they contribute to the overall maternal mortality rate shown in Table 10.2. In future the majority of these Late deaths from causes unrelated to pregnancy, especially those which occur six months or more after delivery, will only be subject to minimal data collection.
Table 10.1 Causes of Other Indirect deaths; United Kingdom: 1997-2005. Cause 1997-99 2000-02 2003-05 Diseases of the central nervous system 34 40 37 Subarachnoid haemorrhage 11 17 11 Intracerebral haemorrhage 5 3 11 Cerebral thrombosis 5 4 2 Epilepsy 9 13 11 Other 4 3 2 Infectious diseases 13 14 16 Human Immunodefi ciency virus 1 4 5 Bacterial infection 8 6 5 Other 4 4 6 Diseases of the respiratory system 9 10 5 Asthma 5 5 4 Other 4 5 1 Endocrine, metabolic and immunity disorders 6 7 5 Diabetes mellitus 4 3 1 Other 2 4 4 Diseases of the gastrointestinal system 7 7 9 Intestinal obstruction 3 2 0 Pancreatitis 2 1 2 Other 2 4 7 Diseases of the blood 4 2 4 Diseases of the circulatory system 2 3 6 Diseases of the renal system 0 3 1 Cause unknown 0 4 4 Total 75 90 87 133
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Confidential Enquiry into Maternal
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Saving Mothers’ Lives: Reviewing
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Contents Maternal deaths Indirectly
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Foreword Having a baby is a joyous
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The ‘top ten’ key recommendatio
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Migrant women 4. All pregnant mothe
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Clinical skills 7. Maternity servic
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Early warning scoring system 9. The
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References 1 Redshaw M, Rowe R, Hoc
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Working together to save mothers’
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Severe maternal morbidity, “near
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At a national level In every countr
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Table 1 Defi nitions of maternal de
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For the past nine years, ONS have b
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Chapter 1 Which mothers died, and w
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Key fi ndings for 2003-05 Maternal
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Figure 1.1: Overall maternal mortal
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Coincidental deaths The deaths of 5
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Leading causes of maternal deaths:
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Table 1.5 Maternal deaths by gestat
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Table 1.7 Number of maternal deaths
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of note is that every women who die
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Table 1.11 Numbers and percentage o
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These messages are repeated in many
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Doctors may need specifi c training
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Table 1.13 Total number of Direct a
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Ovarian hyperstimulation syndrome (
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The obese women who died From the n
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Pre-pregnancy counselling and weigh
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Table 1.19 Direct and Indirect mate
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double the number of cases in the l
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was ill and he should take her to a
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Table 1.22 Characteristics of the a
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Most staff reported learning clinic
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exception. The health service has a
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17 Shah A, Sands J, Kenny L. Matern
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Country of birth and migration A fa
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Table A1.4 Direct and Indirect deat
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Body mass index varies with age, be
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2 Thrombosis and thromboembolism Ja
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Pulmonary embolism Of the 33 women
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Family history In two deaths there
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vigilance and take symptoms serious
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Deaths after caesarean section Seve
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of pregnancy, seven had identifi ab
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Annex 2.1 Summary of the key recomm
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The grades of recommendations (B or
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High risk patients Patients assesse
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Table 3.2 Numbers of deaths from pr
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publication from the United States
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References 1 Knight M, Kurinczuk JJ
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obstetricians and anaesthetists rou
Page 109 and 110: Detailed guidelines for the managem
Page 111 and 112: acute bleeding situation although i
Page 113 and 114: References 1 Brace V, Penney G, Hal
Page 115 and 116: Table 5.1 Direct deaths attributed
Page 117 and 118: of over ten litres. Despite a hyste
Page 119 and 120: References 1 Clark SL, Pavlova Z, G
Page 121 and 122: The women who died The ages of the
Page 123 and 124: A woman who had not been long in th
Page 125 and 126: 7 Genital tract sepsis Ann Harper G
Page 127 and 128: Sepsis in early pregnancy Six women
Page 129 and 130: Box 7.3 Learning points: Sepsis in
Page 131 and 132: Risk factors for, and the identifi
Page 133 and 134: Box 7.7 Features of septicaemic sho
Page 135 and 136: 8 Anaesthesia Griselda Cooper and J
Page 137 and 138: The third case also highlights the
Page 139 and 140: A woman suffered a concealed haemor
Page 141 and 142: Sepsis Poor anaesthetic or resuscit
Page 143 and 144: What did you learn from this case a
Page 145 and 146: 9 Cardiac disease Catherine Nelson-
Page 147 and 148: Table 9.2 Causes of maternal death
Page 149 and 150: an estimated incidence of 1.1 per 1
Page 151 and 152: Quality of care Care was considered
Page 153 and 154: y a doctor, with a systolic blood p
Page 155 and 156: Box 9.3 Learning points: peripartum
Page 157 and 158: Infectious endocarditis Two women d
Page 159: 10 Other Indirect deaths Michael de
Page 163 and 164: Fifty-eight of the eighty-seven wom
Page 165 and 166: Previous Reports have emphasised th
Page 167 and 168: Aspergillosis usually occurs in imm
Page 169 and 170: Liver disease There were four mater
Page 171 and 172: Diseases of the circulatory system
Page 173 and 174: 11 Cancer and other tumours Gwyneth
Page 175 and 176: her delivery, but her case should h
Page 177 and 178: Severe abdominal and back pain, sci
Page 179 and 180: References 1 Drife, J O. The contri
Page 181 and 182: Psychiatric deaths: Specifi c recom
Page 183 and 184: cut off point for maternal deaths,
Page 185 and 186: Report, 26 deaths from suicide were
Page 187 and 188: Current psychiatric treatment In th
Page 189 and 190: 12 Deaths from psychiatric causes S
Page 191 and 192: caring for the woman. Nonetheless,
Page 193 and 194: Commentary on deaths related to dru
Page 195 and 196: It is known that women presenting w
Page 197 and 198: antibiotics nor returned to her gen
Page 199 and 200: It is still evident that there is a
Page 201 and 202: 13 Domestic abuse Gwyneth Lewis Dom
Page 203 and 204: The mothers affected: 2003-05 Durin
Page 205 and 206: Of the women who were murdered: •
Page 207 and 208: Annex 13.1 The recommendations of t
Page 209 and 210: Road traffi c accidents during and
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Table 14.2 Late deaths known, or no
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Table 15.2 Quality of autopsy repor
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Haemorrhage Thirteen of the sevente
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association with obesity as eight o
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Obesity was present in 55% of these
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Toxicology showed non-lethal citalo
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Box 15.6 Pathology learning points:
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References 1 Royal College of Patho
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16 Issues for midwives Grace Edward
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effective service for women who may
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Professional accountability and com
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Box 16.1 Key physical signs that ma
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Midwives’ responsibility for vuln
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Table 16.1 Poor or non attenders fo
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Action checklist for midwifery prac
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17 Issues for General Practitioners
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Box 17.1 Summary of the key issues
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Box 17.3 Risk factors for venous th
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headaches. The indications for emer
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Box 17.8 GP learning points: Heartb
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medication after delivery and been
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Women with mitral stenosis may seem
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signifi cance in the pregnancy. It
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References 1 RCOG. Thromboprophylax
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Introduction For the fi rst time in
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measures were of a good or excellen
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A woman collapsed at home following
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never preclude requesting opinion f
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admissions represented 0.9% of all
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Modifi ed early warning scoring sys
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Box 19.3 Critical care learning poi
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her initial collapse she was transf
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Chapter 19 Annex A This Annex is av
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Table 20.1 Inclusion criteria used
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Table 20.3 Numbers and rates of sev
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References 1 Baskett TF,.O’Connel
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The Director of the Maternal Death
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Verifi cation of Ascertainment Asce
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Scotland A single panel of assessor
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CEMACH Regional Managers East of En
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Regional Assessors in Pathology Eas
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NORTHERN IRELAND Department of Heal
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267
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Saving Mothers' Lives: - Public Health Agency for Northern Ireland

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