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

Chapter 1 Which mothers died, and why
Gwyneth Lewis • Statistical analysis by Alison Macfarlane
Summary of key points
• Maternal deaths are extremely rare in the United Kingdom. The maternal mortality rate for 2003-05
calculated from all maternal deaths directly or indirectly due to pregnancy identifi ed by this Enquiry
was 14 per 100,000 maternities. Although this is a slight increase from the last Report, it is not
statistically signifi cant.
• If, as is the case in other countries, the numbers of maternal deaths are restricted to those identifi ed
by the underlying cause of death given on death certifi cates alone, the UK maternal death rate was
7 per 100,000 maternities, half that identifi ed by this much more in-depth Enquiry.
• The maternal mortality rate for those mothers’ deaths that could only be due to pregnancy e.g.
haemorrhage or eclampsia, i.e. Direct deaths, showed a slight increase for this triennium compared
to the last Report. This is not statistically signifi cant.
• The mortality rate for mothers’ deaths from Indirect causes, i.e. from pre-existing or new medical or
mental health conditions aggravated by pregnancy such as heart disease, has not changed since
the last Report. Although the maternal death rate from Indirect causes was still higher than for
deaths from Direct causes, the gap between them was smaller
• Many possible factors lie behind the lack of decline in the maternal mortality rate. They include rising
numbers of older or obese mothers, women whose lifestyles put them at risk of poorer health and a
growing proportion of women with medically complex pregnancies. Because of the rising numbers
of births to women born outside the UK, the rate may also be infl uenced by the increasing number
of deaths of migrant women.These mothers often have more complicated pregnancies, more
serious underlying medical conditions or may be in poorer general health. They can also experience
diffi culties in accessing maternity care.
• More than half of all the women who died from Direct or Indirect causes, for whom information was
available, were either overweight or obese. More than 15% of all women who died from Direct or
Indirect causes were morbidly or super morbidly obese.
• The commonest cause of Direct death was again thromboembolism. Despite apparent slight rises
in rates of death from thromboembolism, pre-eclampsia/ eclampsia and genital tract sepsis and
apparent slight declines in rates of death from haemorrhage and direct uterine trauma, none of
these differences were statistically signifi cant. There has also been an apparently inexplicable rise in
deaths from amniotic fl uid embolism, a rare and largely unavoidable condition.
• Cardiac disease was the most common cause of Indirect deaths as well as of maternal deaths
overall. In the main this refl ects the growing incidence of acquired heart disease in younger women
related to less healthy diets, smoking, alcohol and the growing epidemic of obesity.
• There has been a decrease in the rate of suicide, the overall leading cause of death in the last
Report. If sustained in the next Report, this decline may indicate that the recommendations made
in previous Reports concerning identifying women at potential risk in the antenatal period, and
developing management plans for them, are having a benefi cial effect.
• Whilst there has been no increase in the number of cases associated with sub-standard care, or
avoidable factors, a number of health care professionals failed to identify and manage common
medical conditions or potential emergencies outside their immediate area of expertise. Resuscitation
skills were also considered poor in some cases.
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