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

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30 1 Which mothers died, and why Table 1.18 Numbers and estimated rates of maternal death by type and ethnic group per 100,000 maternities; England only: 2003-05. Ethnic group Direct deaths Indirect deaths Numbers Numbers Total Direct and Indirect deaths Numbers Rate 95 per cent CI for rate Relative risk compared with white 95 per cent CI for relative risk Estimated number of maternities White 71 91 162 11.1 9.5 12.9 1.0 - - 1,462,537 Mixed 0 1 1 5.2 0.9 29.5 0.5 0.1 3.4 19,232 Black African 15 15 30 62.4 43.7 89.0 5.6 3.8 8.3 48,103 Black Caribbean 7 2 9 41.1 21.6 78.1 3.7 1.9 7.3 21,910 Indian 2 7 9 20.3 10.7 38.6 1.9 0.9 3.6 44,288 Pakistani 3 3 6 9.2 4.1 20.1 0.8 0.4 1.9 64,993 Bangladeshi 3 3 6 23.6 10.8 51.4 2.1 0.9 4.8 25,455 Chinese and other Asian 1 0 1 14.0 2.5 79.2 1.3 0.2 9.0 7,146 Middle east 4 3 7 32.0 15.5 66.1 2.9 1.4 6.2 21,845 Other 1 1 2 28.0 7.7 10.2 2.5 0.6 10.2 7,146 Total 107 126 233 13.5 11.9 15.4 1,722,655 These rates and relative risks are based on small numbers and the coding of ethnicity may be problematic so they should be interpreted with caution. Nevertheless, analysis of the English data suggests that for Black African women and, to a lesser extent Black Caribbean and Middle Eastern women, the mortality rate is signifi cantly higher than that for White women. This may not only refl ect the cultural factors implied in ethnicity but their social circumstances and the fact that some of them may have recently migrated to the United Kingdom under less than optimal circumstances. Table 1.19 shows the main causes of death by ethnic group, and Table 1.20 their access to care.
Table 1.19 Direct and Indirect maternal deaths by major ethnic group; England: 2003-05. Direct White Black African Black Caribbean Indian Pakistani Bangladeshi Chinese and Asian Middle Eastern Other Not stated Thromboembolism 30 3 3 0 2 0 1 1 1 0 41 Pre-eclampsia/ eclampsia 12 2 2 0 0 1 1 1 0 0 19 Haemorrhage 7 2 1 1 2 1 1 1 1 0 17 AFE 11 4 0 1 0 1 0 0 0 0 17 Early pregnancy 12 2 0 0 0 0 0 0 0 0 14 Sepsis 14 3 1 0 0 0 0 0 0 0 18 Anaesthetic 5 0 0 0 0 0 1 0 0 0 6 All Direct 91 16 7 2 4 3 4 3 2 0 132 Indirect Cardiac 33 6 1 4 0 1 2 0 1 0 48 Other Indirect 59 10 1 3 3 4 3 2 1 1 87 Psychiatric Indirect 16 2 0 0 0 0 0 0 0 0 18 Indirect malignancies 8 1 0 1 0 0 0 0 0 0 10 All Indirect 116 19 2 8 3 5 5 2 2 1 163 Total 207 35 9 10 7 8 9 5 4 1 295 Total 31
Page 1 and 2:
Confidential Enquiry into Maternal
Page 3 and 4:
Saving Mothers’ Lives: Reviewing
Page 5 and 6:
Contents Maternal deaths Indirectly
Page 7 and 8: Foreword Having a baby is a joyous
Page 9 and 10: The ‘top ten’ key recommendatio
Page 11 and 12: Migrant women 4. All pregnant mothe
Page 13 and 14: Clinical skills 7. Maternity servic
Page 15 and 16: Early warning scoring system 9. The
Page 17 and 18: References 1 Redshaw M, Rowe R, Hoc
Page 19 and 20: Working together to save mothers’
Page 21 and 22: Severe maternal morbidity, “near
Page 23 and 24: At a national level In every countr
Page 25 and 26: Table 1 Defi nitions of maternal de
Page 27 and 28: For the past nine years, ONS have b
Page 29 and 30: Chapter 1 Which mothers died, and w
Page 31 and 32: Key fi ndings for 2003-05 Maternal
Page 33 and 34: Figure 1.1: Overall maternal mortal
Page 35 and 36: Coincidental deaths The deaths of 5
Page 37 and 38: Leading causes of maternal deaths:
Page 39 and 40: Table 1.5 Maternal deaths by gestat
Page 41 and 42: Table 1.7 Number of maternal deaths
Page 43 and 44: of note is that every women who die
Page 45 and 46: Table 1.11 Numbers and percentage o
Page 47 and 48: These messages are repeated in many
Page 49 and 50: Doctors may need specifi c training
Page 51 and 52: Table 1.13 Total number of Direct a
Page 53 and 54: Ovarian hyperstimulation syndrome (
Page 55 and 56: The obese women who died From the n
Page 57: Pre-pregnancy counselling and weigh
Page 61 and 62: double the number of cases in the l
Page 63 and 64: was ill and he should take her to a
Page 65 and 66: Table 1.22 Characteristics of the a
Page 71 and 72: Most staff reported learning clinic
Page 73 and 74: exception. The health service has a
Page 75 and 76: 17 Shah A, Sands J, Kenny L. Matern
Page 77 and 78: Country of birth and migration A fa
Page 79 and 80: Table A1.4 Direct and Indirect deat
Page 81 and 82: Body mass index varies with age, be
Page 83 and 84: 2 Thrombosis and thromboembolism Ja
Page 85 and 86: Pulmonary embolism Of the 33 women
Page 87 and 88: Family history In two deaths there
Page 89 and 90: vigilance and take symptoms serious
Page 91 and 92: Deaths after caesarean section Seve
Page 93 and 94: of pregnancy, seven had identifi ab
Page 95 and 96: Annex 2.1 Summary of the key recomm
Page 97 and 98: The grades of recommendations (B or
Page 99 and 100: High risk patients Patients assesse
Page 101 and 102: Table 3.2 Numbers of deaths from pr
Page 103 and 104: publication from the United States
Page 105 and 106: References 1 Knight M, Kurinczuk JJ
Page 107 and 108: obstetricians and anaesthetists rou
Page 109 and 110:
Detailed guidelines for the managem
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acute bleeding situation although i
Page 113 and 114:
References 1 Brace V, Penney G, Hal
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Table 5.1 Direct deaths attributed
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of over ten litres. Despite a hyste
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References 1 Clark SL, Pavlova Z, G
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The women who died The ages of the
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A woman who had not been long in th
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7 Genital tract sepsis Ann Harper G
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Sepsis in early pregnancy Six women
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Box 7.3 Learning points: Sepsis in
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Risk factors for, and the identifi
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Box 7.7 Features of septicaemic sho
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8 Anaesthesia Griselda Cooper and J
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The third case also highlights the
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A woman suffered a concealed haemor
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Sepsis Poor anaesthetic or resuscit
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What did you learn from this case a
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9 Cardiac disease Catherine Nelson-
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Table 9.2 Causes of maternal death
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an estimated incidence of 1.1 per 1
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Quality of care Care was considered
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y a doctor, with a systolic blood p
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Box 9.3 Learning points: peripartum
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Infectious endocarditis Two women d
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10 Other Indirect deaths Michael de
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Table 10.1 Causes of Other Indirect
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Fifty-eight of the eighty-seven wom
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Previous Reports have emphasised th
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Aspergillosis usually occurs in imm
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Liver disease There were four mater
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Diseases of the circulatory system
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11 Cancer and other tumours Gwyneth
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her delivery, but her case should h
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Severe abdominal and back pain, sci
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References 1 Drife, J O. The contri
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Psychiatric deaths: Specifi c recom
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cut off point for maternal deaths,
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Report, 26 deaths from suicide were
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Current psychiatric treatment In th
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12 Deaths from psychiatric causes S
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caring for the woman. Nonetheless,
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Commentary on deaths related to dru
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It is known that women presenting w
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antibiotics nor returned to her gen
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It is still evident that there is a
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13 Domestic abuse Gwyneth Lewis Dom
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The mothers affected: 2003-05 Durin
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Of the women who were murdered: •
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Annex 13.1 The recommendations of t
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Road traffi c accidents during and
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Table 14.2 Late deaths known, or no
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Table 15.2 Quality of autopsy repor
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Haemorrhage Thirteen of the sevente
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association with obesity as eight o
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Obesity was present in 55% of these
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Toxicology showed non-lethal citalo
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Box 15.6 Pathology learning points:
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References 1 Royal College of Patho
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16 Issues for midwives Grace Edward
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effective service for women who may
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Professional accountability and com
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Box 16.1 Key physical signs that ma
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Midwives’ responsibility for vuln
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Table 16.1 Poor or non attenders fo
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Action checklist for midwifery prac
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17 Issues for General Practitioners
Page 243 and 244:
Box 17.1 Summary of the key issues
Page 245 and 246:
Box 17.3 Risk factors for venous th
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headaches. The indications for emer
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Box 17.8 GP learning points: Heartb
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medication after delivery and been
Page 253 and 254:
Women with mitral stenosis may seem
Page 255 and 256:
signifi cance in the pregnancy. It
Page 257 and 258:
References 1 RCOG. Thromboprophylax
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Introduction For the fi rst time in
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measures were of a good or excellen
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A woman collapsed at home following
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never preclude requesting opinion f
Page 267 and 268:
admissions represented 0.9% of all
Page 269 and 270:
Modifi ed early warning scoring sys
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Box 19.3 Critical care learning poi
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her initial collapse she was transf
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Chapter 19 Annex A This Annex is av
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Table 20.1 Inclusion criteria used
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Table 20.3 Numbers and rates of sev
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References 1 Baskett TF,.O’Connel
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The Director of the Maternal Death
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Verifi cation of Ascertainment Asce
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Scotland A single panel of assessor
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CEMACH Regional Managers East of En
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Regional Assessors in Pathology Eas
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NORTHERN IRELAND Department of Heal
Page 295 and 296:
267
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Saving Mothers' Lives: - Public Health Agency for Northern Ireland

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