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

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10 Other Indirect deaths
Endocrine, metabolic and immunity disorders
The conditions in this diverse group are counted together for the sake of continuity with previous Reports
and some are discussed more fully here.
Diabetes
Only one Indirect death was reported from diabetes in this triennium, and three additional Late deaths. One
of the Late deaths occurred in a woman who developed diabetes in pregnancy which, in retrospect, was
probably the fi rst manifestation of type 1 diabetes. Unfortunately, she did not receive any medical follow up
after delivery, insulin was stopped and she died of diabetic ketoacidosis.
Systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS)
There were four cases of lupus and/or antiphospholipid syndrome. In one of these cases, pulmonary
hypertension was a contributing factor to the woman’s death. In another:
A woman was diagnosed with APS following multiple pregnancy losses. She rapidly developed
end stage renal failure but conceived while being dialysed. Pregnancy was not considered a
cause for her amenhorrhoea until she had a routine pregnancy test taken for x-ray imaging but
by then she was in mid pregnancy. She had good combined care but suffered an early placental
abruption requiring an emergency caesarean section. She then developed coagulopathy, rapidly
deteriorated and died from a haemopericardium.
Pregnancies are still being missed in women on dialysis who have amenhorrhoea. In addition she should
have had been offered pre-pregnancy counselling regarding the possible poor maternal and fetal outcome
of pregnancy with women with APS, renal failure and on haemodialysis.
There were several other deaths in which SLE or APS played a part. One was a Late death from a
stroke in a woman with APS and a poor obstetric history. Another woman, with severe SLE, died from
cardiomyopathy and her death is counted in Chapter 9 - Cardiac disease. The death of a further woman
with SLE is counted in Chapter 4 - Haemorrhage, because she died from postpartum haemorrhage due to
placenta percreta which was almost certainly not connected with lupus. A woman with congenital adrenal
hyperplasia who died from sepsis following prolonged rupture of membranes is counted in the Sepsis
Chapter (Chapter 7). Her glucocorticoid treatment would have made her more susceptible to infection.
Gastrointestinal disease
Hyperemesis
There were three deaths in association with hyperemesis. One is counted in Chapter 2 -
Thromboembolism, because she died from cerebral vein thrombosis; one is counted in Chapter 9 - Cardiac
disease, because she died suddenly and unexpectedly though hypokalaemia from prolonged vomiting may
have been a factor; the other is counted here:
A multigravid woman had hyperemesis again, having had it in each of her previous pregnancies.
She was admitted to a gynaecology ward, given fl uids and discharged some days later with
instructions to attend her GP for follow up. A few weeks later she was found dead at home having
suffered a massive haemorrhage from a tear in the oesophagus (Mallory Weiss syndrome).
Mallory Weiss syndrome is a very rare complication of hyperemesis and it is even rarer for it to be fatal.