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

LewisThere were cases where a major failure of communicationbetween healthcare workers may have contributed to thewoman’s death. Notably, these included GPs not beingasked for information or not being consulted about furtherreferral and, in some cases, the GP not being informed thatthe woman was pregnant. The converse was also true, withthe GP not passing on information relevant to the woman’shealth and well-being. In addition, the assessors have beenstruck by the lack of further referral by hospital obstetriciansto senior specialists of potentially high-risk cases.Underlying health statusAgeAs in previous Reports, the recognised association betweenmaternal age and risk of pregnancy-related death, as shownin Table 1.15 and Figure 1.5, remains. In this, as in previoustriennia, the highest maternal mortality rates are among theolder mothers. In this Report, the youngest mother who diedwas aged 15 and the oldest was 47 years of age. Four girlswho died were aged between 15 and 16, two of whom diedfrom Direct causes, one of which occurred later in the postnatalyear. Two of these were living in the care of social servicesand another was well known to them. Four of the tenyoung mothers aged between 17 and 19 years were alsoknown to social services. Two were also described as being‘learning disabled’, two used illegal drugs and one was consideredto be homeless, having been recently discharged fromthe care of social services.ParityThe parity of the women who died is given in Table 1.16.Because there are no reliable population denominator datafor parity, it is not possible to calculate specific maternalmortality rates. Rates are, however, available for singletonand multiple births, and these are shown in Table 1.17.These show that the increased maternal mortality rate associatedwith multiple births in the previous two triennia ismaintained. Women with multiple pregnancies appear tobe four times (95% CI 2.3–6.6) more likely to die of apregnancy-related complication than women expecting onlyone child, but care should be taken in interpreting thisbecause of the very small numbers involved.Assisted reproductionEight women whose deaths are counted in this Report wereknown to have undergone assisted reproductive techniques(ART), including in vitro fertilisation, for infertility, four ofwhom died from Direct or Indirect causes, compared withnine in the previous Report. Because it is not possible toseparate UK citizens from visitors from overseas who underwentprivate in vitro fertilisation treatment, it is not possibleto obtain specific denominator data and therefore provide amaternal mortality rate for UK citizens only. Furthermore, itis not possible to calculate an overall mortality rate for ART,because many of the overseas women will have gone back totheir own countries to give birth and are lost to UK followup. But, based on the findings of earlier Reports where thedata were analysed irrespective of citizenship and place ofTable 1.15. Total number of Direct and Indirect deaths by age (in years) of the women who died and rate per 100 000 maternities; UK: 1985–2008Under 20 20–24 25–29 30–34 35–39 40 and over Not stated All agesNumbers1985–87 15 47 53 60 35 13 0 2231988–90 17 38 74 57 31 18 3 2381991–93 7 30 87 61 36 7 1 2291994–96 15 40 71 70 53 11 8 2681997–99 19 34 60 66 50 13 0 2422000–02 16 30 70 79 47 19 0 2612003–05 15 39 66 91 64 20 0 2952006–08 13 36 59 58 71 24 0 261Rates per 100 000 maternities1985–87 7.6 7.1 6.7 13.6 22.8 48.4 9.81988–90 8.8 6 8.9 11.5 18.7 57.4 10.11991–93 4.2 5.5 10.6 10.9 19.1 20.6 9.91994–96 10.2 9 9.6 11.5 24.1 29.1 12.21997–99 11.7 8.9 9.3 10.5 19.2 29.0 11.42000–02 10.6 8.2 13.0 13.2 16.2 35.6 13.12003–05 9.9 9.8 12.4 14.5 19.1 29.4 14.02006–08 8.6 8.2 9.7 9.2 18.8 29.2 11.444 ª 2011 Centre for Maternal and Child Enquiries (CMACE), BJOG 118 (Suppl. 1), 1–203