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

Chapter 9: Cardiac diseaseTable 9.2. Causes of maternal death from cardiac disease; UK: 1994–2008Type and cause of death 1994–96 1997–99 2000–02 2003–05 2006–08AcquiredAortic dissection 7 5 7 9 7Myocardial infarction (MI) 6 5 8 12 6Ischaemic heart disease (no MI) 0 0 0 4 5Sudden adult death syndrome (SADS) 0 0 4 3 10Peripartum cardiomyopathy 4 7 4 0* 9**Other cardiomyopathy 2 3 4 1 4Myocarditis or myocardial fibrosis 3 2 3 5 4Mitral stenosis or valve disease 0 0 3 3 0Thrombosed aortic or tricuspid valve 1 0 0 0 2Infective endocarditis 0 2 1 2 2Right or left ventricular hypertrophy or1 2 2 2 1hypertensive heart diseaseCongenitalPulmonary hypertension (PHT) 7 7 4 3 2Congenital heart disease (not PHT or3 2 2 3 1thrombosed aortic valve)Other 5 0 2 0 0Total 39 35 44 48*** 53*Twelve Late deaths reported in 2003–05.**Two Late deaths reported in 2006–08.***Includes one woman for whom information on cause was not available.were attributed to congenital heart disease. There were tworelated to chronic thromboembolism, one to sleep apnoeaand one to connective tissue disease. Fourteen cases wereknown before pregnancy and ten were diagnosed duringpregnancy.Acquired heart diseaseMyocardial infarction and ischaemic heart diseaseEleven women died from acute myocardial infarction (MI)or chronic ischaemic heart disease (IHD), a rate of 0.48(95% CI 0.27–0.87) per 100 000 maternities compared withthe 16 whose deaths were considered in the last Report, arate of 0.76 (95% CI 0.46–1.2) per 100 000 maternities.Coronary atheroma was the underlying pathology in threeof the six women who died from MI; one of these deathswas the result of extensive coronary artery dissection, arecognised complication of pregnancy and in the two otherwomen the cause of death was undetermined. There werealso five deaths from IHD where no acute MI was demonstrated.Presumably death in these women related toarrhythmia or heart failure. In total, eight women died fromIHD compared with 12 in the previous triennium.The women who diedAgain, as shown in the last Report, the impact of lifestylefactors such as increasing maternal age, obesity and smokingwas dramatic, and all of the women who died had identifiablerisk factors. The mothers’ ages ranged from 28 to46 years with a median of 36 years. Eight women were 35or older, of whom five were aged 40 years or more. All wereparous, and seven were para 4 or greater, of whom twowere of extremely high parity. Six smoked, four had knownhypertension, four were overweight and three were obese.Two had a family history of cardiac disease, one had hypercholesterolaemia,one had gestational diabetes and one hadsickle cell disease. Three women were from black andminority ethnic groups. Three mothers also had social problems:two were known to the child protection services, oneof whom had also reported domestic violence, and anotherwoman abused cannabis and alcohol.All but two of these women died postnatally, althoughone had collapsed antenatally near term.Maternal morbidity from acute myocardialinfarctionThe UKOSS study of acute MI in pregnancy, undertakenbetween August 2005 and February 2010, 1 identified 23confirmed nonfatal cases occurring antenatally, giving anestimated incidence of 0.7 (95% CI 0.4–1.0) cases per100 000 maternities. Fourteen of the women with a confirmedMI had angiography: seven had coronary atheroma,three had coronary artery dissection, two hadcoronary arterial thrombosis and two had normal coro-ª 2011 Centre for Maternal and Child Enquiries (CMACE), BJOG 118 (Suppl. 1), 1–203 111