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

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212 16 Issues for midwives References 1 International Confederation of Midwives (2005) International Defi nition of a Midwife. http://www.internationalmidwives.org/modules 2 Royal College of Midwives. Position Paper 26. Refocusing the Role of the Midwife RCM. London : RCM: .2006. 3 Lewis G (ed). Why Mothers Die The Sixth Report of the Confi dential Enquiries into Maternal Deaths in the United Kingdom 2000-02. London: RCOG Press; 2004. 4 Department of Health. Maternity Matters. Choice, access and continuity of care in a safe service. London: Department of Health; 2007. 5 A Framework for Maternity Services in Scotland (2003): Overview Report of the Expert Group on Acute Maternity Services, Scottish Executive Board. 6 National Collaborating Centre for Women’s and Children’s Health (2003). Antenatal care: Routine Care for the Healthy Pregnant Woman. Available at www.nice.org.uk 7 Nursing and Midwifery Council .The NMC code of professional conduct:, standards for conduct, performance and ethics. London: NMC; 2004. 8 All Wales Normal Birth Pathway (2007). http://www.wales.nhs.uk 9 Langley C. A pathway to normal labour. RCM Midwives Journal, Volume 10, Number 2. London:Royal College of Midwives:2007 . 10 Department of Health. Responding to Domestic Abuse: a Handbook for Health Professionals. London: DoH;2006. 11 Department of Health. Defi nitions of Overweight and Obesity. London: DoH; 2007. www.doh.gov.uk 12 Bolling K, Grant C, Hamlyn B, Thornton A. Infant Feeding Survey 2005. Leeds: The Information Centre for Health and Social Care, 2007. 13 Redshaw M, Rowe R, Hockley C, Brocklehurst P. Recorded delivery: a national survey of women’s experience of maternity care. Oxford: National Perinatal Epidemiology Unit; 2006. 14 The National Childbirth Trust, The Royal College of Midwives, The Royal College of Obstetricians And Gynaecologists. Maternity Care Working Party : Modernising Maternity Care – A commissioning toolkit for England. (2nd Edition). London: NCT; 2006.
17 Issues for General Practitioners Judy Shakespeare General Practice: Specifi c recommendations Communications • GPs should ensure they undertake a careful risk assessment during telephone consultations with, or concerning, women who are or who may be pregnant. If they are in any doubt they should see the woman or arrange an appropriate referral for her. • Whenever possible, the GP should give the woman’s named midwife confi dential access to her full written and electronic records. • GPs should ensure that any signifi cant letters are copied into the woman’s hand-held maternity record. • Midwives should ensure that all investigations that they initiate are copied to the GP. Making urgent referrals • There needs to be a routine system in every maternity service by which GPs, midwives and obstetricians can communicate rapidly with one another, and seek advice, if a woman’s condition gives rise to concern. This might be phone, fax or email. For this purpose conventional referral letters are inadequate and take too long. Referral management systems must not impede access to urgent appointments. • A GP should make “fast track” referrals directly to appropriate physicians if women have serious medical conditions such as congenital cardiac disease or epilepsy at the onset of pregnancy. They should not rely only on conventional referral pathways to an obstetrician or midwive as this introduces delays that may compromise the woman’s health. Migrant women and women who do not speak English • A medical assessment of general health before or at booking of migrant women may prevent complications or even death in later pregnancy. This should include a cardiovascular examination, performed by an appropriately trained doctor, who could be their usual GP. • Relatives should not act as interpreters. Funding must be made available for interpreters in the community, especially in emergency or acute situations. Obesity • GPs should record the Body Mass Index of pregnant women and those contemplating pregnancy, and should counsel obese women before and during pregnancy regarding weight loss or healthy eating. • Women with obesity are not suitable for GPmidwifery-led care because their pregnancies are higher risk. These women should be referred for specialist care because of possible co-morbidity. 213
Page 1 and 2:
Confidential Enquiry into Maternal
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Saving Mothers’ Lives: Reviewing
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Contents Maternal deaths Indirectly
Page 7 and 8:
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
Page 13 and 14:
Clinical skills 7. Maternity servic
Page 15 and 16:
Early warning scoring system 9. The
Page 17 and 18:
References 1 Redshaw M, Rowe R, Hoc
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Working together to save mothers’
Page 21 and 22:
Severe maternal morbidity, “near
Page 23 and 24:
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
Page 29 and 30:
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
Page 37 and 38:
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
Page 49 and 50:
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:
Page 71 and 72:
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
Page 105 and 106:
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
Page 113 and 114:
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
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an estimated incidence of 1.1 per 1
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Quality of care Care was considered
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y a doctor, with a systolic blood p
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Box 9.3 Learning points: peripartum
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Infectious endocarditis Two women d
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10 Other Indirect deaths Michael de
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Table 10.1 Causes of Other Indirect
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Fifty-eight of the eighty-seven wom
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Previous Reports have emphasised th
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Aspergillosis usually occurs in imm
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Liver disease There were four mater
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Diseases of the circulatory system
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11 Cancer and other tumours Gwyneth
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her delivery, but her case should h
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Severe abdominal and back pain, sci
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References 1 Drife, J O. The contri
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Psychiatric deaths: Specifi c recom
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cut off point for maternal deaths,
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Report, 26 deaths from suicide were
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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 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: Action checklist for midwifery prac
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
Page 251 and 252: medication after delivery and been
Page 253 and 254: Women with mitral stenosis may seem
Page 255 and 256: signifi cance in the pregnancy. It
Page 257 and 258: References 1 RCOG. Thromboprophylax
Page 259 and 260: Introduction For the fi rst time in
Page 261 and 262: measures were of a good or excellen
Page 263 and 264: A woman collapsed at home following
Page 265 and 266: never preclude requesting opinion f
Page 267 and 268: admissions represented 0.9% of all
Page 269 and 270: Modifi ed early warning scoring sys
Page 271 and 272: Box 19.3 Critical care learning poi
Page 273 and 274: her initial collapse she was transf
Page 275 and 276: Chapter 19 Annex A This Annex is av
Page 277 and 278: Table 20.1 Inclusion criteria used
Page 279 and 280: Table 20.3 Numbers and rates of sev
Page 281 and 282: References 1 Baskett TF,.O’Connel
Page 283 and 284: The Director of the Maternal Death
Page 285 and 286: Verifi cation of Ascertainment Asce
Page 287 and 288: Scotland A single panel of assessor
Page 289 and 290: CEMACH Regional Managers East of En
Page 291 and 292:
Regional Assessors in Pathology Eas
Page 293 and 294:
NORTHERN IRELAND Department of Heal
Page 295 and 296:
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