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

Lewismaternal mortality rates or ratios, they may contain importantmessages for the providers of maternity care. Clinically,the lessons may include basic principles for themanagement of pregnant or recently delivered women withunderlying medical or psychiatric conditions. From a public-healthperspective, the continuing assessment of suchdeaths re-enforces the need for information on the correctuse of seat belts in pregnancy, and, perhaps most importantly,the identification and management of pregnantwomen who suffer from physical, verbal or emotionalabuse. Issues related to domestic abuse, recommendationsand suggested guidelines have been fully described in specificchapters in the previous two Reports of this Enquiry.The main findings for this triennium, which remain largelyunchanged, are discussed at the end of this Chapter (inAnnex 12.1), and readers are referred to previous Reportsand other references for more detailed information.Summary of key findings for 2006–08Coincidental deathsIn this triennium, the deaths of 50 women who died ofCoincidental causes either during their pregnancy or within42 days of delivery were reported to this Enquiry, comparedwith 55 for the previous triennium. As in previousReports, and as shown in Table 12.1, the largest overall categorywere deaths due to ‘unnatural’ causes, largely roadtraffic accidents, murder or unintentional overdoses ofstreet drugs. Some women who died from other medicalcauses such as pneumonia are included in this section, astheir pregnancies (invariably at an extremely early gestation)were only discovered during the autopsy. The deathsof nine women who died from Coincidental malignanciesare discussed in Chapter 10 and those associated with substanceabuse are discussed in Chapter 11. By chance, andnot representative of the number of women who died fromTable 12.1. Coincidental maternal deaths reported to the Enquiry;UK: 2006–08Cause of deathCoincidental duringpregnancy and upto and including42 days after deliveryUnnatural deathsRoad traffic accident 17Murder 11Overdose of street6drugs/drug-relatedHouse fire/burns 1Cancer (see Chapter 10) 9Medical conditions 6All Coincidental deaths 50Late Coincidental causes, the Enquiry was notified of ninesuch deaths this triennium; seven were the result of overdosesof street drugs and two were from medical conditions.These are not used in statistical calculations.As with previous Reports, and other causes of death, manyof the women whose deaths are counted here were vulnerableand socially excluded. The general lessons to be drawn fromthis group of mothers have been discussed in Chapter 1.Road traffic accidentsThe Enquiry received reports on the deaths of 17 womenwho died as the result of road traffic accidents during pregnancyor within 6 weeks of delivery during this triennium.In two deaths, the women were under the influence ofdrugs or alcohol, in one of which the mother had recentlyhad her baby taken into care. In the opinion of the assessors,there is the possibility that this accident may havebeen intentional. In another example where suicide mightalso have been a possibility, a mother in mid-pregnancywas suffering from depression and had required hospitalisationfollowing assaults from her violent partner, who hadrecently given her a sexually transmitted disease. She hadalso had a number of previous terminations, all signs ofhaving a violent, controlling partner.Two pregnant women were pedestrians hit by motorvehicles. One, who was hit on a motorway, had a chaoticlifestyle, was addicted to street drugs and had all her previouschildren taken into care. She was approaching anotherchild protection conference when she died. Here, too, thequestion remains about why she was walking on a motorwayin the first place.All but two of the women were still pregnant when theydied, and in only one woman was there clear evidence thatshe was not wearing a seat belt. In four women, a perimortemcaesarean section was performed in the EmergencyDepartment. The gestations ranged from 24 to 41 weeks;none of the babies survived.The advice for the use of seat belts in pregnancy is givenin the overall recommendations at the start of this chapter.Late deathsAs previously discussed, apart from all nine Late Direct and24 Late Indirect deaths assessed as having been related topregnancy, notably because of puerperal psychosis and cardiomyopathy,from which important lessons for maternitycare can still be drawn, other deaths in women in their firstpostnatal year have not generally been assessed this triennium.There were, however, nine examples of such LateCoincidental deaths for which assessments were made, largelyto exclude them being assessed as the result of LateIndirect causes. Therefore, apart from Direct and certainIndirect Late deaths, due to the more limited assessment ofmost other later deaths this triennium, these numbers and144 ª 2011 Centre for Maternal and Child Enquiries (CMACE), BJOG 118 (Suppl. 1), 1–203