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

of pregnancy, seven had identifi able risk factors. Four were obese or morbidly obese. We repeat our
previous recommendation that public health education is necessary so that women at risk because of their
weight, family history or past history can seek advice before becoming pregnant.
The inappropriate classifi cation of obese women, and those with complex pregnancies and risky lifestyles,
as “low risk” is a worrying trend. A full risk and needs assessment in early pregnancy must be undertaken
before care plans are decided. Partly as a result of recommendations made in preceding Reports, and
in Maternity Matters 6 , NICE is in the process of developing such a risk assessment tool which should
be used at all booking appointments as soon as it is available. Antenatal care must refl ect clear and
objective judgement and this point is also made in the midwifery Chapter (Chapter 16) of this Report. Again
we repeat the recommendation that “All women should undergo an assessment of risk factors in early
pregnancy or before pregnancy. This assessment should be repeated if the woman is admitted to hospital
or develops other intercurrent problems.”
False reassurance, including reassurance over the telephone when the woman has not even been
examined, is another worrying trend which is also picked up in the new Chapter for GPs. Early symptoms
of life-threatening embolism are generally mild and reassurance is too easy to give and accept.
Finally, our examination of these 41 cases reinforces our view that only a national survey such as this can
draw useful conclusions about emerging trends. Refl ection on individual cases in Trusts is necessary but
local investigations may be insuffi ciently self-critical or indeed too self-critical, and may not reveal important
new factors such as the high risks run by morbidly obese women. Our main recommendation for this
triennium is that there is an urgent need for a guideline on management of obese pregnant women.
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