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

Women with mitral stenosis may seem well in early pregnancy but they commonly decompensate at
the end of the second trimester. Referring women with unexplained murmurs to a cardiologist early in
pregnancy would enable earlier diagnosis of rheumatic heart disease and catastrophic deterioration may
be prevented with proper assessment, monitoring and intervention.
Tuberculosis
Two cases of tuberculous meningitis in pregnancy were diagnosed late, as often happens, and both
occurred in women whose families were from the Asian sub-continent. In one case the diagnosis was
delayed as the husband was acting as the interpreter, a recurrent feature amongst other deaths in women
who could not speak English. In one case her GP commented that this was a particular problem in his
practice because there was no agreed source of funding for interpreters.
Box 17.10
GP learning points: refugees and asylum seekers
Newly arrived women, especially refugees and asylum seekers, are at higher risk of illnesses that
are no longer familiar in the UK and this needs to be born in mind when caring for sick women from
these communities.
A medical assessment of general health before booking of immigrant women may prevent death later
in pregnancy. This should include a cardiovascular examination, performed by an appropriately trained
doctor, who could be their usual GP.
The risks of obesity in pregnancy
Obesity represents one of the greatest and growing overall threats to the childbearing population of the
UK. Fifteen percent of women who died from Direct or Indirect causes and who had a BMI recorded had
BMIs of 35 or over, with half of these having BMIs exceeding 40. A further 12% of women had BMIs in the
range 30-34 and and 24% had BMIs of 25-29. Obese women predominated among those who died from
thromboembolism, sepsis and cardiac disease. There are many other aspects of the care of overweight
women in pregnancy that cause concern beyond maternal risks, including the diffi culties of prenatal
diagnosis, the enhanced risk of gestational diabetes, the increased chance of caesarean section, and the
challenges of analgesia and anaesthesia. The risks of obesity are discussed in more detail in Chapter 1.
Communications
Problems in communication are at the heart of many of the cases discussed in this Report and this Chapter
has already raised issues about communication with patients, within the primary health care team and
between GPs, midwives and specialists.
Telephone consultations
Telephone consultations are increasingly being used in medical contacts, including the triage of acute
illnesses. They are acceptable to patients, and clinicians also value them but have anxieties about missing
serious conditions9 . There are cases described in this Report, and earlier in this Chapter, which underline
this concern. The case of a woman who died from pulmonary embolus, described earlier, is an example
where the quality of telephone assessment was poor and may have contributed to her death. There
is evidence that telephone consultations are shorter than face-to-face consultations10 but there is little
evidence about the quality of care. Telephone consultations require an additional range of skills since the
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