6.-March-2011-Saving-Mothers-Lives-reviewing-maternal-deaths-to-make-motherhood-safer-2006-2008

McClure, CooperWorkloadA number of case reports highlight that peak labour wardactivity coincided with the emergency admission of a pregnantwoman with an acute, severe illness. Many notes suggestthat the midwifery, obstetric and anaesthetic workforcewas already fully committed at times of peak activity innormal workload. This produces difficulties if a pregnantwoman with an acute, severe illness is admitted andrequires high-dependency care in addition. When staffinglevels are calculated on average activity, there needs to be aclear contingency plan for all disciplines to obtain furtherskilled assistance.Workload: learning pointA clear contingency plan to provide additional skilledassistance should be in place if maternity staff arealready fully committed at times of peak activity, if awoman with an acute, severe illness requires highdependencycare.Serious incidents and hospital enquiriesMost maternal deaths within hospital now initiate a fullserious incident or internal hospital enquiry, the reports ofwhich were available to the Regional and Central Assessors.These reports are still of variable quality and clearly completedin-house and therefore open to bias. Hospital managersare again asked to consider whether unbiased externalinput would assist in this process and ensure greater objectivity.Disclosure of interestsJ McClure was a Clinical Research Fellow for one year(1979) sponsored by Astra Pharmaceuticals (now AstaZeneca)and has undertaken consultancy work and one sponsoredlecture tour since – the association ended over10 years ago.G Cooper has no interests to disclose.FundingThis work was undertaken by the Centre for Maternal andChild Enquiries (CMACE) as part of the CEMACH programme.The work was funded by the National PatientSafety Agency; the Department of Health, Social Servicesand Public Safety of Northern Ireland; NHS QualityImprovement Scotland (NHS QIS); and the ChannelIslands and Isle of Man.AcknowledgementsThis Chapter has been peer reviewed by the new CentralAnaesthetic Assessors, Dr Steve Yentis, Consultant Anaesthetistfor Chelsea and Westminster Hospital and Dr PaulClyburn, Consultant Anaesthetist for University Hospital ofWales and the UK Regional Assessors in Anaesthesia. jReferences1 Difficult Airway Society Guidelines. [www.das.uk.com/guidelines/downloads.html]. Accessed 9 September 2010.2 Scott DB. Endotracheal intubation: friend or foe. BMJ1986;292:157–8.3 Department of Health and Social Security. Report on confidential enquiriesinto maternal deaths in England and Wales 1967–1969. London,UK: HMSO, 1972.4 CCT in Anaesthetics. Curriculum, annex B—basic level training.[www.rcoa.ac.uk/docs/CCTAnnexB.pdf]. Accessed 9 September2010.5 Searle RD, Lyons G. Vanishing experience in training for obstetricgeneral anaesthesia: an observational study. Int J Obstet Anesth2008;17:233–7.6 Rahman K, Jenkins JG. Failed tracheal intubation in obstetrics: nomore frequent but still managed badly. Anaesthesia 2005;60:168–71.7 Bromiley M. Have you ever made a mistake? A Patient Liaison GroupDebate. R Coll Anaesth Bull 2008;48:2442–5.8 Rhodes A, Hughes KR, Cohen DG. An argument for orogastric tubesduring caesarean section. Int J Obstet Anesth 1996;5:156–9.9 Knight M. Peripartum hysterectomy in the UK: management andoutcomes of the associated haemorrhage. BJOG 2007;114:1380–7.10 CMACE/RCOG. Management of women with obesity in pregnancy.London, UK: Centre for Maternal and Child Enquiries and Royal Collegeof Obstetricians and Gynaecologists. March 2010. [www.cmace.org.uk].Accessed 9 September 2010.11 Howell C, Grady K, Cox C. Managing Obstetric Emergencies andTrauma—the MOET Course Manual, 2nd edn. London, UK: RCOGPress; 2007.12 Resuscitation Council (UK). Anaphylaxis algorithm. London: ResuscitationCouncil (UK), 2008.13 The Association of Anaesthetists of Great Britain & Ireland AnaphylaxisGuideline. Management of a Patient with Suspected AnaphylaxisDuring Anaesthesia: Safety drill. London: the Association ofAnaesthetists of Great Britain & Ireland, 2009.14 Royal College of Obstetricians and Gynaecologists. Green-TopGuideline No. 37. Reducing the risk of thrombosis and embolismduring pregnancy and the puerperium. London: Royal College ofObstetricians and Gynaecologists, 2009.108 ª 2011 Centre for Maternal and Child Enquiries (CMACE), BJOG 118 (Suppl. 1), 1–203