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

vigilance and take symptoms seriously. These lessons were reinforced in the other two deaths in early
pregnancy. It is important also to remember that when breathlessness fi rst appears in late pregnancy,
pulmonary embolism should be considered.
In all four cases the women were inappropriately reassured by GPs and/or hospital staff including
obstetricians, midwives and physicians. Of course clinical judgement is imperfect but these cases are a
reminder of how subtle the symptoms of thromboembolism can be, and of how careful staff should be
before offering reassurance.
Deaths after ectopic pregnancy or termination of pregnancy
One woman died after laparoscopic salpingectomy for early ectopic pregnancy despite the use of
antiembolism boots and graduated compression stockings. Two other deaths in early pregnancy occurred
after terminations of pregnancy and the lessons from these three cases suggest there is insuffi cient
knowledge that such women are at risk. For example:
A young woman with complex social problems and a history of domestic abuse underwent a midtrimester
termination of pregnancy. Three weeks later she attended the Emergency Department
(ED) with chest pain and a pulse rate of 120 bpm. A diagnosis of “urinary tract infection or pelvic
infl ammatory disease” was made, and she was referred to the gynaecological team but not
admitted. She died a few days later.
Chest pain and tachycardia in an apyrexial woman who has recently been pregnant are suggestive of
pulmonary embolism or other serious cardiorespiratory pathology, as is sudden onset breathlessness,
which was misattributed to anaemia in the other case.
Intrapartum deaths
There were no intrapartum deaths from pulmonary embolism in this triennium.
Deaths after vaginal delivery
Eight women died after vaginal delivery. Six women had delivered spontaneously and two by vacuum
extraction. Known risk factors were present in seven of these cases; three were either overweight or
obese, three were morbidly obese with BMIs exceeding 40 and one mother was aged over 40. In the
remaining two cases the mothers’ weight was not recorded. Five of the deaths were between postpartum
days 8 and 28, as shown in Table 2.4.
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