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

Nelson-PiercyTable 9.1. Indirect maternal deaths from congenital and acquired cardiac disease and rates per million maternities: UK: 1985–2008Triennium Congenital Acquired TotalnIschaemicOtherRate95% CIn (%) n (%) n (%)1985–87 10 (43) 9 (39) 4 (17) 23 1.01 0.68 1.521988–90 9 (50) 5 (28) 4 (22) 18 0.76 0.48 1.211991–93 9 (24) 8 (22) 20 (54) 37 1.60 1.16 2.201994–96 10 (26) 6 (15) 23 (59) 39 1.77 1.30 2.431997–99 10 (29) 5 (14) 20 (57) 35 1.65 1.19 2.292000–02 9 (20) 8 (18) 27 (61) 44 2.20 1.64 2.962003–05 4 (8) 16 (33) 28 (58) 48* 2.27 1.67 2.962006–08 3 (6) 8 (15) 42 (79) 53 2.31 1.77 3.03*Includes one woman for whom very little information was available.arising from cardiomyopathy: two from peripartum cardiomyopathy,one from arrhythmogenic right ventricularcardiomyopathy, one from cardiomyopathy related to systemiclupus erythematosus, one secondary to anthrocyclineand one from dilated cardiomyopathy that could have beenperipartum cardiomyopathy or secondary to thyrotoxicosis.There were two Late Coincidental deaths in intravenousdrug users because of infective endocarditis.Three other maternal deaths to which cardiac disease contributedare counted and considered in other Chapters. Oneassociated with ischaemic cardiac disease in early pregnancyis counted in Chapter 6, one with myocardial scarring fromcocaine use is counted in Chapter 8, and one from secondaryacute endocarditis is counted in Chapter 10.Summary of key findings: 2006–08Table 9.2 shows the overall numbers of cardiac maternaldeaths by major cause for this, and previous, triennia. Theleading causes are sudden adult death syndrome (SADS),of which there has been a significant increase; myocardialinfarction, mostly related to ischaemic heart disease;dissection of the thoracic aorta and cardiomyopathy, mostcommonly peripartum cardiomyopathy. Deaths from pulmonaryhypertension and from congenital heart diseasecontinue to decrease. There were no deaths from rheumaticheart disease in the current triennium.Thirty of the 50 (60%) women who died from cardiacdisease and for whom a body mass index (BMI) was availablewere overweight or obese. Half of them had a BMI of30 or more.The assessors considered that some degree of substandardcare was present in 27 of the 53 (51%) deathscounted in this Chapter. In 13 deaths, there were major lessonsto be learnt, and, if the care had been better, the outcomemay have been different. For 14 women, the carethey received was less than optimal and lessons can belearnt from their management, but the outcome wouldhave been inevitable. The varying reasons for this are discussedthroughout this Chapter.Congenital heart disease andpulmonary hypertensionThe deaths of four women who died from the complicationsof congenital heart disease or from pulmonaryvascular disease are counted in this Chapter, and onewoman whose cardiac disease complicated her pregnancy iscounted in Chapter 4. One died following heart transplantation,one from a thrombosed aortic valve and two frompulmonary hypertension. Of these latter two, one wasprobably the result of complications associated with anatrial septal defect.Even though these mothers’ deaths could not have beenprevented, care was considered suboptimal in somewomen. This was because of a lack of pre-pregnancy counselling,failure to refer to the cardiologists, a lack ofcommunication between specialists and inappropriate managementof anticoagulation.Maternal morbidity from pulmonary vasculardiseaseOver the 4-year period between March 2006 and February2010, 24 confirmed cases of pulmonary vascular diseasewere reported through the United Kingdom Obstetric SurveillanceSystem (UKOSS; Detailed information on theUKOSS is given in the Introductory Chapter to thisreport), giving an estimated incidence of 0.8 (95% CI 0.5–1.2) per 100 000 maternities. 1 Eleven were due to the resultof idiopathic pulmonary arterial hypertension, and nine110 ª 2011 Centre for Maternal and Child Enquiries (CMACE), BJOG 118 (Suppl. 1), 1–203