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

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APPENDIX 1: Method of Enquiry
Naufi l Alam
The Confi dential Enquiry into Maternal and Child Health (CEMACH) has fi ve regional offi ces in England
and works with partner offi ces in Wales, Northern Ireland and Scotland. The work is co-ordinated by
a Central Offi ce in London. Each of the regional offi ces has contacts within every Trust that provides
maternity care, at the Maternity-Unit level.
The Enquiry has its own Board with representation from the Royal College of Obstetricians and
Gynaecologists (which hosts the Enquiry), Royal College of Midwives, Royal College of Pathologists,
Faculty of Public Health, Royal College of Paediatrics and Child Health, and the Royal College of
Anaesthetists. Recent additions to the board include the Royal College of General Practitioners and the
Royal College of Psychiatrists.
From 2003 to 2005, CEMACH was commissioned by the National Institute for Clinical Excellence (NICE)
to conduct the Maternal Death Enquiry (MDE) in England and Wales. Since 2005, this commissioning
role has been carried out by the National Patient Safety Agency (NPSA). In Northern Ireland CEMACH is
commissioned by the Northern Ireland Department of Health, which contributes funds for their participation
in the Enquiry. In Scotland, the Scottish Programme for Clinical Effectiveness in Reproductive Health
(SPCERH), acting on behalf of NHS Quality Improvement Scotland (NHSQIS) conducts its own Enquiry
programme, but cases are forwarded to the Enquiry’s central assessors and included in the triennial Report.
England and Wales
It is a government requirement that all maternal deaths should be subject to this Confi dential Enquiry, and
all health professionals have a duty to provide the information required. In participating in the Confi dential
Enquiry, the professionals concerned are asked for three things:
(i) to provide a full and accurate account of the circumstances leading to the woman’s death,
with supporting records
(ii) to refl ect on any clinical or other lessons that have been learned, either personally or as
part of the wider context
The responsibility for initiating an enquiry into maternal death lies with the CEMACH Regional Manager
(RM). Following a pregnancy-associated-maternal-death, a notifi cation is usually made by one of the health
professionals involved in the care of the woman to the relevant CEMACH RM. Cases are also reported
by the coroners, Local Supervising Authority Midwifery Offi cers (LSAMO), and others. Data are also cross
validated with data received from the Offi ce for National Statistics (ONS). The data received from ONS are
discussed more fully below (see “Verifi cation of Ascertainment”).
The enquiry is initiated using a standard data collection form (Maternal Enquiry pro forma; MDR-1) which
is completed by obstetricians, anaesthetists, pathologists, general practitioners, midwives and any other
professionals that were involved in the care of the woman. Copies of case notes are obtained, where
relevant, and in some cases additional written statements are supplied. Each case is then prepared for a
two stage review and assessment process, the fi rst occurring at a regional level, and the second occurring
at a central level. Following collection of all the relevant information, the records are anonymised and
circulated by the CEMACH Regional Manager to Regional Assessors (RA). The obstetric and midwifery
assessors review all cases. Anaesthetic assessors review all cases where there was involvement of an
anaesthetic or intensive care. Every possible attempt is made to obtain full details of any autopsy and
pathological investigations, and these are reviewed by the pathology assessor. The assessors add their
comments and opinions regarding the cause or causes of death, before returning the completed form to
the relevant Regional Offi ce where core notifi cation data are entered onto a database.