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

Chapter 7: SepsisTable 7.1. Direct deaths associated with genital tract sepsis and rate per 100 000 maternities; UK: 1985–2008TrienniumSepsisin earlypregnancy*PuerperalsepsisSepsisafter surgicalproceduresSepsis beforeor during labourAll Direct deaths countedin this ChapterLate Directdeaths**n Rate 95% CI n1985–87 3 2 2 2 9 0.40 0.21–0.75 01988–90 8 4 5 0 17 0.72 0.45–1.15 01991–93 4 4 5 2 15 0.65 0.39–1.07 01994–96 0 11 3 1 16 0.73 0.45–1.18 01997–99 6 2 1 7 18 0.85 0.54–1.34 22000–02 2 5 3 1 13 0.65 0.38–1.11 02003–05 5 3 2 8 18 0.85 0.54–1.35 32006–08 7 7 4 8 26 1.13 0.77–1.67 3*Early pregnancy deaths include those following miscarriage, ectopic pregnancy and other causes.**Late deaths are not counted in this Chapter or included in the numerator.Rate per 100 000 maternities1.81.61.41.21.00.80.60.40.20.0Test for trend over period 1985–2008: P = 0.011985–87 1988–90 1991–93 1994–96 1997–99 2000–02 2003–05 2006–08TrienniumFigure 7.1. Deaths from genital tract sepsis, rates per 100 000 maternities; UK: 1985–2008The women who diedThe ages of the women who died, including the three whodied later in the postnatal period, ranged from 15 to41 years with a median age of 34 years. Most were in stablefamily relationships with no significant social issues. Tenwere from minority ethnic groups, six of whom were asylumseekers or recent immigrants, including one migrantworker from a new European Union country who spokeno English. One such mother was not booked until late inher pregnancy although she had regularly attended theEmergency Department with pregnancy-related problems.Four women did not speak English, and, in all cases, closefamily members provided interpretation. The inappropriatenessof this and lack of interpretation services is a recurringtheme in this Report and one for which an overallrecommendation has been made.Most women had normal body mass index (BMI) orwere slightly overweight with ranges between 18 and 35with a median of 23.5, but five had a BMI > 30. This differsfrom the last triennium where the majority of thewomen who died from sepsis were overweight or obese.Nine were primigravid. Eight women died from sepsisbefore 24 weeks of gestation, with loss of all fetuses. Twelvewomen had a vaginal delivery, and nine had a caesareansection after 24 weeks of gestation. Sixteen of their babiessurvived; there were five stillbirths.Substandard careSome mothers had excellent or outstanding care, but forothers there were missed opportunities for early intervention.Lessons can be learnt from the management of 18 ofthe 26 (69%) mothers who died during pregnancy or withinª 2011 Centre for Maternal and Child Enquiries (CMACE), BJOG 118 (Suppl. 1), 1–203 87