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

Oates et al.Back to basicsM Oates 1 , A Harper 2 , J Shakespeare 3 , C Nelson-Piercy 41 East Midlands Perintal Mental Health Clinical Network, Nottinghamshire Healthcare NHS Trust, Nottingham, UK; 2 Royal Jubilee MaternityServices, Royal Maternity Hospital, Belfast, UK; 3 Summertown Health Centre, Oxford, UK; 4 Guy’s & St Thomas’ Foundation Trust andImperial College Healthcare Trust, Women’s Health Directorate, London, UKCorrespondence: Margaret R Oates, East Midlands Perintal Mental Health Clinical Network, Nottinghamshire Healthcare NHS Trust, DuncanMacMillan House, Porchester Road, Nottingham NG3 6AA, UK. Email: margaret.oates@nottshc.nhs.ukKeywords recommendations, Confidential Enquiry, maternal,mortality.IntroductionSeveral common themes that need to be recognised by allprofessionals providing maternity care have emerged fromall the Chapters of this Report. To aid learning and clinicalpractice, some key overall good practice points have beenbrought together in this new section of the Report. The lessonsfall into the following main categories:• improving basic medical and midwifery practice, suchas taking a history, undertaking basic observations andunderstanding normality• attributing signs and symptoms of emerging seriousillness to commonplace symptoms in pregnancy• improving communication and referrals.This aide memoire does not cover every eventuality andshould be taken as a signpost to help identify and excludethe commoner disorders of pregnancy. It is not, however,exclusive, nor does it replace the need for all health professionalsto be up to date with their clinical practice and followthe relevant clinical guidelines. An in-depth discussion of allof these issues as they relate to specific causes of death can befound in the individual chapters of Report, which should beread in conjunction with this aide memoire.Common symptomsPyrexiaAlthough still very uncommon, deaths from sepsis, especiallycommunity-acquired streptococcal Group A, have increasedover the last 10 years. In part, this mirrors the increased incidenceof strep A in the general population, but, whereassome maternal deaths from sepsis are unavoidable, otherscould still be avoided by earlier identification and treatment.Becoming life-threateningly ill from sepsis, and streptococcalsepsis in particular, shows the speed with which women canbecome sick in pregnancy, sometimes dying within 12–24 hours of first developing symptoms.A raised temperature during pregnancy, labour or thepuerperium is usually caused by common minor ailmentssuch as a cold, ‘flu’ or other viral illness. But these arediagnoses by exclusion. Pyrexia can be a sign of more seriousinfection, including puerperal sepsis, chorioamnionitisor other genital tract sepsis, wound or breast infection,pyelonephritis or pneumonia, which may lead to systemicsepsis causing significant maternal morbidity and maternaland fetal mortality. In some of the women with sepsisdescribed in this Report, earlier recognition of the severityof the illness and recording of temperature and other vitalsigns or earlier action on abnormal results might haveallowed earlier treatment and possibly a better outcome.Sore throatSore throat is a very common symptom in primary care. Itcan sometimes be caused by Group A streptococcal infection.A throat swab should be taken when a pregnant orrecently delivered woman presents with a sore throat, andthere should be a lower threshold for antibiotic treatmentin primary care. The Centor Criteria 1 are shown in the boxbelow:Antibiotic prescribing for sorethroatsIf three of the following criteria are positive, then antibioticsare indicated 1 :• history of fever• tonsillar exudate• no cough• tender anterior cervical lymphadenopathy.16 ª 2011 Centre for Maternal and Child Enquiries (CMACE), BJOG 118 (Suppl. 1), 1–203