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

Table 20.1
Inclusion criteria used in 2003-05
Code Category Defi nition
1
Major obstetric
haemorrhage
2 Eclampsia
3
Renal or Liver
dysfunction
4 Cardiac arrest No detectable major pulse.
5 Pulmonary oedema
6
Acute respiratory
dysfunction
Estimated blood loss ≥2,500ml, or transfused fi ve or more units of blood, or
received treatment for coagulopathy (fresh frozen plasma, cryoprecipitate,
platelets). (Includes ectopic pregnancy meeting these criteria.)
Seizure associated with antepartum, intrapartum or postpartum symptoms and
signs of pre-eclampsia.
Acute onset of biochemical disturbance, urea > 15mmol/l, creatinine >400mmol/l,
aspartate aminotransferase / alanine aminotransferase >200u/l.
Clinically diagnosed pulmonary oedema associated with acute breathlessness
and 0 2 saturation < 95%, requiring 0 2 , diuretics or ventilation.
Requiring intubation or ventilation for >60 minutes (not including duration of
general anaesthetic).
7 Coma Including diabetic coma. Unconscious >12 hours
8
Cerebro-vascular
event
Stroke, cerebral/cerebellar haemorrhage or infarction, subarachnoid
haemorrhage, dural venous sinus thrombosis.
9 Status epilepticus Unremitting seizures in a patient with known epilepsy.
10 Anaphylactic shock
11 Septicaemic shock
An allergic reaction resulting in collapse with severe hypotension, diffi culty
breathing and swelling/rash.
Shock (systolic blood pressure 20 per minute), tachycardia, hypotension.
Diagnosed as ‘high’ probability on V/Q scan or positive spiral chest CT scan.
Treated by heparin, thrombolysis or embolectomy.
Unit equipped to ventilate adults. Admission for one of the above problems or for
any other reason. Include admissions to Coronary Care Units.
During the 2003 to 2005 triennium, 845 women were reported as meeting one or more of our defi ned
inclusion criteria. Using a denominator of 159,223 maternities, the rate of severe maternal morbidity during
the triennium was 5.3 with a 95% confi dence interval from 5.0 to 5.7 per 1000 maternities). During the
triennium, 15 Direct or Indirect maternal deaths were reported to the Confi dential Enquiry into Maternal
Deaths in Scotland; giving a ‘near-miss to death ratio’ of 56:1, with a 95% CI from 34:1 to 100:1.
Many women met the defi nitions for more than one severe morbidity category. For example, some suffered
major haemorrhage and were admitted to intensive care. Thus, during the triennium the 845 women who
were reported to us experienced a total of 1,135 events meeting our inclusion criteria. Rates of the 14
individual categories of severe morbidity are summarised in Table 20.2. Major obstetric haemorrhage
was the most numerous category occurring in 582 women during the triennium. Thus major haemorrhage
occurred in 69% of all 845 women with severe maternal morbidity.
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