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

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10 Other Indirect deaths
haemorrhage. She continued to deteriorate and was looked by a number of different high
dependency units before transfer to Critical Care for ventilation and died soon after. During her
admission she was never cared for on any maternity unit.
As with another case of pneumoccocal meningitis this woman had numerous attendances before the
diagnosis of tuberculosis meningitis was made. Multiple attendances without a diagnosis are a danger sign.
If it was thought that this woman had tuberculosis in pregnancy she should have been admitted to hospital
rather than sent to a tuberculosis clinic. Sub-standard care was also demonstrated by the lack of maternity
staff input when she delivered and had a postpartum haemorrhage, and by the fragmented admission policy
with her multiple sites of care. It was not clear who, if anyone, was responsible for her care.
Incidence of tuberculosis in pregnancy
As deaths from tuberculosis appear to be increasing a prospective national study of tuberculosis in
pregnancy was undertaken by the United Kingdom Obstetric Surveillance System (UKOSS) from February
2005 to August 20061 . Over this period, there were 52 confi rmed cases, representing an incidence rate of
4.6 per 100,000 maternities with a 95 % confi dence interval from 3.4 to 8.0.
Pneumonia
Three women died from pneumonia, two from bacterial infection and one thought to be due to atypical
organisms. There was also one late death from pneumonia. One of these women presented very late for
antenatal care:
A young woman with needle phobia repeatedly failed to attend for care, despite reminders. Early in
her third trimester she was admitted via the ED in labour and with fever, tachycardia and markedly
reduced oxygen saturation. When transferred to the labour ward she was very unwell but initially refused
intravenous access although intravenous antibiotics were started some hours later. She was delivered
soon after and died of multi-organ failure a day or two later. It transpired that she had been ill for several
days before her admission but had refused to come to hospital until she was in labour. Streptococcus
pneumoniae was grown from her blood and sputum.
Fungal infection
In a very rare case, a woman died from septicaemia due to urinary tract infection and renal calculus,
which caused a reactivation of a pre-existing peptic ulcer and subsequent blood vessel rupture further
precipitated by fungal superinfection. A further death arising directly from fungal infection illustrates
diffi culties in obtaining specialised medical advice outside the remit of clinical obstetrics:
A multigravid asylum seeker had an uneventful pregnancy though she did attend the neurology
clinic where “chronic daily headache” was diagnosed. Her young son always translated for her. She
was admitted in late pregnancy with headache and objective evidence of weakness in the left arm
and leg but discharged after a few days with no fi rm diagnosis being made. She was readmitted
some days later with headache, pyrexia and photophobia, again seen by a medical registrar and
quickly discharged. One week later she presented to the antenatal clinic unable to walk and was
admitted to a neurology ward, a right-sided space occupying brain lesion having been found in
a CT scan organised by the obstetricians via the ED. She was admitted via the ED because the
neurology department could not or would not see her urgently even though she could not walk.
She deteriorated rapidly and delivered by emergency caesarean section but a brain biopsy showed
aspergillus and she died a few days later.