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

Verifi cation of Ascertainment
Ascertainment is checked with reference to data supplied by ONS. This data are supplied in two forms:
(i) Direct Notifi cations; these are deaths of women where “pregnancy” is mentioned anywhere
on the ONS death registration. These cases are coded as a maternal death according to the
International Classifi cation of Diseases, Injuries and Causes of Death tenth revision (ICD10). This
would identify all women where pregnancy may have been a contributing factor to their death.
(ii) Linkage Notifi cations; these are deaths of women where the name of the woman appeared
on the registration of a birth in the current or preceding calendar year. This would allow for the
identifi cation of women who had died up to 364 days following delivery.
This data is cross-matched with the data that has been directly acquired by CEMACH. Any cases that have
been identifi ed by one organisation but not the other would then be established. These outstanding cases
are then further investigated to ensure that they are pregnancy-associated-deaths, and that they warrant
inclusion in the Enquiry and then an enquiry initiated using the standard data collection form.
Regional Assessment
Each CEMACH region has one or more sets of Regional Assessors (RA) depending on requirements.
Each set includes an obstetric assessor, midwifery assessor, pathology assessor, an anaesthetic assessor
and a perinatal psychiatric assessor. Assessors are appointed for the term of the triennium (about 4 years,
allowing for completion of assessment). Nominations for medical assessors are sought from the presidents
of the Royal Colleges, and nominations for midwives are sought from the LSAMO.
An RA must be an active clinical practitioner in the National Health Service (NHS), in the relevant
speciality. If medical, the Regional Assessor should be at consultant level, or, if a midwife, must be at
supervisory level. The Regional Assessor should have knowledge and experience of organisation of care,
as well as the respect of his/her peers. It is important that the Regional Assessor is able to realistically
commit enough time to assess and return enquiry forms in a timely manner. The position is honorary.
The role of the Regional Assessor is to review the information reported in the MDR-1 form, and any other
documents that have been assembled by the CEMACH Regional Manager. The Regional Assessor will
then make a short report in the relevant section of the enquiry form. All the information provided to the
Regional Assessor is anonymised. This report includes a comment on the case, an evaluation of the
clinical management and the resources of the organisation responsible for the care of the woman. The
assessor is also asked to make a judgement as to whether the care was substandard and, if so, if this was
a contributing factor in the death of the mother.
Central Assessment
The Central Assessors review each case thoroughly, taking into account the case history, the results of
pathological investigations, and fi ndings of autopsy that may have been conducted. Following this detailed
investigation, each case is allotted to a specifi c chapter in the fi nal report.
This assessment occasionally varies with the underlying cause of death as given on the death certifi cate,
and classifi ed by the Registrars General using the ICD10. This is because a death may be coded for a
specifi c cause-of-death, but the pathogenesis of this condition may have been precipitated by an obstetric
event. For example, although a given death may be coded as multiple-organ failure as the terminal event,
it could have been precipitated by an obstetric event such as septicaemia from an infected caesarean
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