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

Aspergillosis usually occurs in immunocompromised patients. She was HIV negative but the CT of her
chest showed mediastinal lymphadenopathy suggestive of lymphoma. In this case there were multiple
communication problems not least because of her son acting as her interpreter. Her multiple admissions
with headache and abnormal neurological signs should have provoked earlier imaging. Consultants did
not adequately support the medical trainees working in the clinic and nor were the consultant obstetricians
supported by their consultant colleagues in neurology. This case fl ags up yet again that multiple
attendances without diagnosis are a danger sign, the issues around the provision of interpreting services
and the need for combined neurology or medical / obstetric clinics which would improve the care of
pregnant women with neurological problems.
There was one further death from overwhelming candida infection in a woman counted in the section on
systemic lupus erythematosus.
Viral infection
Six women died from actual or presumed viral disease. Five were from HIV infection, in one of which
earlier referral to a specialist HIV clinic would probably have improved the outcome. In at least one case a
woman attended for care late in pregnancy for fear of stigmatisation. One case of presumed viral disease
raises concerns about the quality of pathology that maternal deaths receive in that her autopsy was
so inadequate a cause of death was hard to establish. As has been repeatedly stated in the Pathology
Chapter (Chapter 15) of this, and previous Reports, the quality of maternal autopsies must be improved.
They often do little more than exclude death from unnatural causes.
The death of another woman with HIV infection and tuberculosis who died of liver failure is discussed
and counted in the section in this Chapter on gastrointestinal disease. There was at least one additional
death from HIV where the notes have not been forthcoming and one Late death each from HIV and
encephalomyelitis.
Diseases of the respiratory system
Asthma
There were four sudden and unpreventable maternal deaths from bronchial asthma. A further woman with
asthma deteriorated throughout pregnancy and died of respiratory failure soon after a caesarean section.
She has therefore been counted as an anaesthetic death and her case is discussed in Chapter 8.
Cystic fi brosis
There are always a few deaths for cystic fi brosis counted in these Reports as women with this condition
have healthier lives, live longer and often wish to have children. In this triennium there was only one
death from cystic fi brosis in a woman with severe disease who elected to continue with her pregnancy
despite counselling about the very high risk of death in her case. She received excellent multidisciplinary
care between the various specialist teams but eventually her respiratory infection fl ared and she started
treatment with a home oxygenator. She died, despite excellent care, a few weeks after an early elective
caesarean section. The outstanding care in her case shows how women with severe life threatening
diseases but who elect for pregnancy can, and must, be supported in their choice.
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