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

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172 12 Deaths from psychiatric causes References 1 O’Hara MW, Swain AM. Rates and risk of postpartum depression - a meta-analysis. Int Rev Psychiatry 1996; 8: 37-54 2 Cox J, Murray D, Chapman G. A controlled study of the onset prevalence and duration of postnatal depression. Br J Psychiatry 1993; 163: 27-41 3 Oates M. Psychiatric Services for women following childbirth. Int Rev Psychiatry 1996; 8: 87-98 4 Kendell RE, Chalmers KC, Platz C. Epidemiology of puerperal psychoses. Br J Psychiatry 1987; 150: 662-73 5 Wieck A, Kumar R, Hirst AD, Marks MN, Campbell IC, Checkley SA. Increased sensitivity of dopamine receptors and recurrence of affective psychosis after childbirth, Br J Psychiatry 1991; 303: 603-16 6 Robertson E, Jones I, Haque S, Holder R, Craddock N. Risk of puerperal and non-puerperal (postpartum) psychosis. Short Report Br J Psychiatry 2005; 186: 258-259 7 Lewis G, Drife J, editors. Why Mothers Die 1997-199. The Fifth Report of the Confi dential Enquiries into Maternal Deaths in the United Kingdom. London: RCOG Press; 2001 8 Why Mothers Die 2000-2002. The Confi dential Enquiry into Maternal and Child Health.. Report on confi dential enquiries into maternal deaths in the United Kingdom. London RCOG Press 2004 9 Dean C, Kendell RE. The symptomatology of puerperal illness. Br J Psychiatry 1981; 139: 128-33 10 National Service Framework for Children, Young People and Maternity Services. Department of Health September 2004 11 NICE Guidelines on Antenatal and Postnatal Mental Health National DoH 2007 12 Appleby L. Suicidal behaviour in childbearing women. Int Rev Psychiatry 1996; 8: 107-15 13 Appleby L, Mortensen, PB, Faragher EB. Suicide and other causes of mortality after postpartum psychiatric admission. Br J Psychiatry 1998; 173(9); 209-211 14 Living in Britain, General Household Survey No 31 (2002), Offi ce of National Statistics 15 The Advisory Council on the Misuse of Drugs. Hidden Harm. Responding to the needs of children f problem drug users. London, ACMD. 2003. www.drugs.gov.uk 16 Scottish Executive. Getting Our Priorities Right: Policy and Practice Guidelines for Working with Children and Families Affected by Problem Drug Use. Edinburgh: Scottish Executive 2003 17 Hogg C, Chadwick T and Dale-Pereira A (LGDF/SCODA). Drug Using Parents: Policy Guidelines for Inter-Agency Working (England and Wales). London: LGA Publications; 1997 18 Drug Misuse and Dependence: Guidelines on Clinical Management of pregnant women http://www.nta.nhs.uk/ 19 British Association for Psychopharmacology (2004) Evidence-based Guidelines for the Pharmacological Management of Substance Misuse, Addiction and Co-morbidity; Recommendations from the British Association for Psychopharmacology.
13 Domestic abuse Gwyneth Lewis Domestic Abuse: New and existing recommendations Once multi-agency support services are in place this Enquiry continues to recommend that routine enquiries should be made about domestic abuse, either when taking a social history at booking, or at another opportune point during a woman’s antenatal period. Whenever possible, all women should be seen alone at least once during the antenatal period to enable disclosure more easily if they wish. When routine questioning is introduced, this must be accompanied by the development of local strategies for referral to a local multidisciplinary support network to whom the woman can be referred if necessary. Local trusts and community teams should develop guidelines for the identifi cation of, and provision for further support for, these women, including developing multi-agency working to enable appropriate referrals or provision of information on sources of further help. Information about local sources of help and emergency helplines such as those provided by Women’s Aid should be displayed in suitable places in antenatal clinics, for example in the women’s toilets or printed as a routine at the bottom of hand-held maternity notes or cooperation cards. Clear, relevant and complete information must be passed from the GP to the antenatal care team, at booking, which accurately details any past current or past medical, psychiatric, social or family history. It must be remembered that health professionals, too, are victims of abuse. Women with known signifi cant features of domestic abuse should not be regarded as “low risk” and should be offered multidisciplinary care in a supportive environment. If they choose midwifery led care the midwife should receive support and advice from an experienced superior. All health professionals should make themselves aware of the importance of domestic abuse in their practice. They should adopt a non-judgemental and supportive response to women who have experienced physical, psychological or sexual abuse and must be able to give basic information to women about where to get help. They should also provide continuing support, whatever decision the woman makes concerning her future. Background Domestic abuse is defi ned by the Home Offi ce as: “Any incident of threatening behaviour, abuse or abuse (psychological, physical, sexual, fi nancial or emotional) between adults who are or have been intimate partners or family members, regardless of gender or sexuality 1 ”. The term “domestic abuse” is now used in preference to “domestic violence”, as the latter could be interpreted as relating to physical abuse alone. It also covers issues that mainly concern women from minority ethnic backgrounds, such as forced marriage, female genital mutilation/cutting (FGM/FGC) and so-called “honour crimes”. 173
Page 1 and 2:
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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Page 69 and 70:
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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
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Sepsis Poor anaesthetic or resuscit
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What did you learn from this case a
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9 Cardiac disease Catherine Nelson-
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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 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: It is still evident that there is a
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
Page 243 and 244: Box 17.1 Summary of the key issues
Page 245 and 246: Box 17.3 Risk factors for venous th
Page 247 and 248: headaches. The indications for emer
Page 249 and 250: Box 17.8 GP learning points: Heartb
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medication after delivery and been
Page 253 and 254:
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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