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

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164 12 Deaths from psychiatric causes A summary profi le of the women who died from suicide is shown in Table 12.7. Table 12.7 Major social and clinical characteristics of the 33 mothers who died from suicide; United Kingdom: 2003-05. Characteristics Number Percentage Socio-demographic White ethnic group 29 88 Died following childbirth 27 82 Aged over 25 23 70 Had previous children 22 67 Unemployed and/ or had a partner unemployed 18 55 Living alone 12 36 Clinical Previous history of psychiatric disorder 21 64 Were seriously ill with a severe depressive illness or psychosis 14 42
Commentary on deaths related to drug and alcohol misuse Judy Myles Introduction Fifty-seven women out of the 98 women whose deaths are discussed in this Chapter had problems with substance abuse. Forty fi ve were misusing drugs and twelve were alcohol dependent. A further six cases of substance abuse were identifi ed this triennium but have not been assessed in this Chapter. Although the majority of those who were drug dependent were using heroin, most were also using methadone, amphetamines, cocaine, benzodiazepines and some alcohol as well. A small number died from suicide, the rest died from an “accidental” but lethal overdose of their drug of abuse, the physical consequences of their abuse or from related medical conditions. Some died from domestic abuse. Many of these women were socially excluded and most were homeless or living in very poor circumstances. The majority were late bookers and poor attenders for antenatal care. Most had previous children in the care of the local authority and were subject to child protection conferences in their current pregnancy. Substance misuse therefore makes a signifi cant contribution to maternal mortality in general and to psychiatric causes of maternal death in particular. As shown in Chapter 1, 11% of all the women who died this triennium, of any cause, had problems with drugs or alcohol. Sixty per cent were registered drug addicts The care of these women during pregnancy and the postnatal period presents a challenge to maternity, drug treatment and social services. Service delivery Although pregnant women are fast tracked into treatment in the majority of drug and alcohol services in the UK, there is still a signifi cant disparity in the numbers of women, in comparison to men, recruited into treatment services. The rate remains at a ratio of three males to one female, despite efforts to increase the number of women attending14 . This is particularly of concern as the numbers of women misusing drugs and alcohol are rising. Women over the age of 16 have markedly increased their levels of harmful and hazardous alcohol consumption in comparison to men. Amongst women between the ages of 16 and 24, 24% have used an illicit drug in the previous year. Both drug and alcohol use in women of fertile age is becoming normative behaviour with a consequent increase in the numbers of exposed pregnancies and the refl ected increase in maternal mortality either directly or indirectly associated with drug or alcohol misuse. It is of utmost priority, therefore, that substance misuse services should provide environments that are acceptable to women of reproductive age, both for access and for retention in treatment. This is particularly an issue for women from ethnic minorities where drug or alcohol use is deemed unacceptable and consequently service access is particularly problematic: A mother of Asian origin died in early pregnancy from hepatic failure. She had been abusing alcohol for several years and had a long history of related gastrointestinal problems. She had not taken up the offer of help from her GP and the local alcohol services. Her GP did not convey this information to the maternity services and her family actively concealed her alcohol problem from those caring for her. This case also illustrates the particular diffi culties that women from an ethnic minority group may have in accessing substance misuse services and the importance of GPs informing maternity services about a previous psychiatric of substance misuse history. 165
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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
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Detailed guidelines for the managem
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acute bleeding situation although i
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References 1 Brace V, Penney G, Hal
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Table 5.1 Direct deaths attributed
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of over ten litres. Despite a hyste
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References 1 Clark SL, Pavlova Z, G
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The women who died The ages of the
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A woman who had not been long in th
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7 Genital tract sepsis Ann Harper G
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Sepsis in early pregnancy Six women
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Box 7.3 Learning points: Sepsis in
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Risk factors for, and the identifi
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Box 7.7 Features of septicaemic sho
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8 Anaesthesia Griselda Cooper and J
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The third case also highlights the
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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 and 160: 10 Other Indirect deaths Michael de
Page 161 and 162: Table 10.1 Causes of Other Indirect
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: caring for the woman. Nonetheless,
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
Page 211 and 212: Table 14.2 Late deaths known, or no
Page 213 and 214: Table 15.2 Quality of autopsy repor
Page 215 and 216: Haemorrhage Thirteen of the sevente
Page 217 and 218: association with obesity as eight o
Page 219 and 220: Obesity was present in 55% of these
Page 221 and 222: Toxicology showed non-lethal citalo
Page 223 and 224: Box 15.6 Pathology learning points:
Page 225 and 226: References 1 Royal College of Patho
Page 227 and 228: 16 Issues for midwives Grace Edward
Page 229 and 230: effective service for women who may
Page 231 and 232: Professional accountability and com
Page 233 and 234: Box 16.1 Key physical signs that ma
Page 235 and 236: Midwives’ responsibility for vuln
Page 237 and 238: Table 16.1 Poor or non attenders fo
Page 239 and 240: Action checklist for midwifery prac
Page 241 and 242: 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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Saving Mothers' Lives: - Public Health Agency for Northern Ireland

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