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

Recommendations

Info

Harper2 Lamagni TL, Efstratiou A, Dennis J, Nair P, Kearney J, George R,et al. Increase in invasive group A streptococcal infections in England,Wales and Northern Ireland, 2008–9. Euro Surveill 2009;14:pii: 19110.3 Royal College of Obstetricians and Gynaecologists. Preterm prelabourrupture of membranes. Green-top Guideline Number 44. London:RCOG, 2006 [www.rcog.org.uk/womens-health/clinicalguidance/preterm-prelabour-rupture-membranes-green-top-44].Accessed 9 October 2010.4 Health Protection Agency. Group A streptococcal infections: 2007/08 seasonal update. Health Protection Report, Health ProtectionAgency News Arch. Volume 2, No. 15; 11 April 2008.5 The Management of Sickle Cell Disease. National Institutes ofHealth. National Heart, Lung and Blood Institute, Division of BloodDiseases and Resources. NIH Publication No. 02-2117, 4th edn.Bethesda (MD): NIH, 2002. pp. 146.6 Royal College of Obstetricians and Gynaecologists. The Care ofWomen Requesting Induced Abortion. Evidence-based ClinicalGuideline Number 7. Guideline Summary. London: RCOG, 2004[www.rcog.org.uk/womens-health/clinical-guidance/care-womenrequesting-induced-abortion].Accessed 9 October 2010.7 Abdalla J, Saad M, Samnani I, Lee P, Moorman J. Central nervoussystem infection caused by Morganella morganii. Am J Med Sci2006;331:44–7.8 Dellinger RP, Levy MM, Carlet JM, Blon J, Parker MM, Jaeschke R,et al. Surviving Sepsis Campaign: International guidelines for managementof severe sepsis and septic shock: 2008: [published correctionappears in Crit Care Med 2008;36:1394–6]. Crit Care Med2008;36:296–327.9 National Collaborating Centre for Women’s and Children’s Health.Intrapartum Care. Care of Healthy Women and Their Babies DuringChildbirth. Clinical guideline 55. London: RCOG Press, 2007.pp. 206 [www.guidance.nice.org.uk/CG55]. Accessed 9 October2010.10 National Collaborating Centre for Women’s and Children’s Health.Caesarean Section. Clinical Guideline. National Institute for Healthand Clinical Excellence. London: RCOG Press, 2004 [www.guidance.nice.org.uk/CG13].Accessed 9 October 2010.11 Royal College of Obstetricians and Gynaecologists. The Managementof Third- and Fourth-Degree Perineal Tears. Green-top GuidelineNumber 29. London: RCOG, 2007 [www.rcog.org.uk/womenshealth/clinical-guidance/management-third-and-fourth-degree-perineal-tears-green-top-29].Accessed 9 October 2010.12 Morgan MS. Diagnosis and management of necrotising fasciitis: amultiparametric approach. J Hosp Infect 2010;75:249–57.96 ª 2011 Centre for Maternal and Child Enquiries (CMACE), BJOG 118 (Suppl. 1), 1–203
Annex 7.1. A possible future approach to case definitionsAnnex 7.1. A possible future approach to casedefinitionsSebastian LucasBackgroundIn previous triennial maternal deaths reviews, as in this,almost all deaths due to Group A beta-haemolytic Streptococcuspyogenes (GAS), as well as other infections that canbe related to pregnancy or delivery, have been discussedand counted in Chapter 7: Sepsis as Direct maternaldeaths from genital tract infection. Other infections unrelatedto the genital tract but whose effects might havebeen amplified by the altered immune state of pregnancy,such as tuberculosis, pneumococcal meningitis and pneumonia,fungal infections and HIV disease are generallyconsidered as Indirect maternal deaths and counted inChapter 10. Similarly, although the 2009–10 H1N1 influenzaepidemic occurred after this triennium, such caseswill be discussed in the next Report and considered to beIndirect deaths.Under ‘genital tract sepsis’ in the last Report, for 2003-5,GAS and E.coli were the commonest causes of infection,and these were considered by subsets: sepsis in early pregnancy;sepsis before delivery; sepsis after vaginal delivery(puerperal sepsis); sepsis after surgery; sepsis before or duringlabour. In the current Report these divisions continueto enable trend analysis, especially since the death ratesfrom GAS have increased, but this Annex explores the possibilityof using a new system for classifying pregnancyrelatedsepsis. This is based on practical experience of septicdeaths in pregnant and non-pregnant women, reviewsof the 2006-08 cases and of the literature, as well as discussionswith microbiologists.As a result, this Annex proposes that, under the systemoutlined here, about one third of the deaths in thistriennium which would currently be considered to bepregnancy-related sepsis, would be no longer classifiableas due to Direct or Indirect causes. Instead, they mayactually be Coincidental to pregnancy. The new systemmay provide a more useful way of considering remediablefactors and of determining the source of infectionand whether it is a hospital care associated infection(HCAI) or community-acquired. Of these, the latter categoryof community-acquired infections are likely to bethe majority.The WHO classification of puerperalsepsisThe World Health Organisation (WHO) 1 in 1995 stratifiedand classified puerperal infections as follows:Puerperal infections – general• Puerperal sepsis and urinary tract infection• Infections related to the birth process, but not of thegenito-urinary tract• Incidental infectionsPuerperal sepsis is then described as follows:Infection of the genital tract occurring at any timebetween rupture of membranes or labour, and the 42ndday postpartum, in which two or more of the following arepresent;• Pelvic pain• Fever• Abnormal vaginal discharge• Abnormal smell of discharge• Delay in reduction of size of uterus.A proposed new pathogeneticclassification of sepsis in pregnancyThe WHO system is a clinical case definition, not a pathologicalclassification, and mainly intended for applicationin resource-poor (ie diagnostic pathology-poor) settings.The proposed new classification system suggested herebuilds on the above concepts. It is based on considerationof the:• timing of infection• source of infection• route of infection into mother• role of operative interventions• type of bacterial infection• pathology – gross and histopathologicalThe proposal identifies five main categories. These areshown in Table A7.1 together with an analysis of how thematernal deaths from sepsis assessed by this Enquiry in theUnited Kingdom for 2006-08 would satisfy these criteria.It is important to note the classifications and numbersdiscussed in this Annex are only suggestions, and for thistriennium the figures quoted in Chapter 7 must be usedas they help identify trends and rates as well as containª 2011 Centre for Maternal and Child Enquiries (CMACE), BJOG 118 (Suppl. 1), 1–203 97
Page 1:
Volume 118, Supplement 1, March 201
Page 4 and 5:
AcknowledgementsSaving Mothers’ L
Page 6 and 7:
AcknowledgementsAcknowledgementsCMA
Page 8 and 9:
Forewordbeen written jointly by a m
Page 10 and 11:
‘Top ten’ recommendationsServic
Page 12 and 13:
‘Top ten’ recommendationscommun
Page 14 and 15:
‘Top ten’ recommendationsof suc
Page 16 and 17:
‘Top ten’ recommendationsMarch
Page 18 and 19:
Oates et al.Back to basicsM Oates 1
Page 20 and 21:
Oates et al.BreathlessnessBreathles
Page 22 and 23:
Oates et al.appropriate pathway of
Page 24 and 25:
LewisIntroduction: Aims, objectives
Page 26 and 27:
LewisAn important limitation of ran
Page 28 and 29:
Lewismaternal and public health-pol
Page 30 and 31:
Lewisresult in a live birth at any
Page 32 and 33:
LewisChapter 1: The women who died
Page 34 and 35:
Lewiswho would not have been identi
Page 36 and 37:
Lewis1098Rate per 100 000 materniti
Page 38 and 39:
LewisTable 1.4. Numbers and rates o
Page 40 and 41:
Lewis2.50Rate per 100 000 materniti
Page 42 and 43:
LewisTable 1.9. Number of maternal
Page 44 and 45:
LewisTable 1.12. Numbers and percen
Page 46 and 47:
LewisThere were cases where a major
Page 48 and 49: LewisBox 1.5. Classifications of Bo
Page 50 and 51: LewisTable 1.20. Number and estimat
Page 52 and 53: LewisNew countries of the European
Page 54 and 55: LewisTable 1.23. Direct and Indirec
Page 56 and 57: LewisTable 1.26. Characteristics* o
Page 58 and 59: Lewis4 Lewis G (ed). The Confidenti
Page 60 and 61: DrifeTable 2.1. Direct deaths from
Page 62 and 63: Drifewomen who died in 2006-08 had
Page 64 and 65: Drifedelivery she became breathless
Page 66 and 67: DrifePathological overviewFourteen
Page 68 and 69: NeilsonChapter 3: Pre-eclampsia and
Page 70 and 71: Neilsontrue, and what might be the
Page 72 and 73: NeilsonConclusionThe number of deat
Page 74 and 75: NormanBackgroundIn the UK, major ob
Page 76 and 77: Normanwhich there was catastrophic
Page 78 and 79: Normanrecommendations made in succe
Page 80 and 81: DawsonBox 5.1. The UK amniotic flui
Page 82 and 83: Dawsontry despite an extensive sear
Page 84 and 85: O’HerlihyTable 6.1. Numbers of Di
Page 86 and 87: O’Herlihytoxic shock syndrome aft
Page 88 and 89: HarperGroup A b-haemolytic streptoc
Page 90 and 91: Harperthe 6-week postnatal period,
Page 92 and 93: Harpera major intrapartum haemorrha
Page 94 and 95: HarperBox 7.1. Signs and symptoms o
Page 96 and 97: Harperwoman was given several litre
Page 100 and 101: LucasTable A7.1 Proposed new catego
Page 102 and 103: Lucasthe same infection scenario as
Page 104 and 105: McClure, CooperChapter 8: Anaesthes
Page 106 and 107: McClure, Cooperaddress, but protoco
Page 108 and 109: McClure, CooperPostpartum haemorrha
Page 110 and 111: McClure, CooperWorkloadA number of
Page 112 and 113: Nelson-PiercyTable 9.1. Indirect ma
Page 114 and 115: Nelson-Piercynary arteries. In view
Page 116 and 117: Nelson-Piercynormal left ventricle
Page 118 and 119: LucasAnnex 9.1. Pathological overvi
Page 120 and 121: Lucasdiac death that is non-ischaem
Page 122 and 123: de Swiet et al.causes but are aggra
Page 124 and 125: de Swiet et al.died of SUDEP before
Page 126 and 127: de Swiet et al.for 6 weeks after de
Page 128 and 129: de Swiet et al.mised. The obstetric
Page 130 and 131: de Swiet et al.CancerPregnancy does
Page 132 and 133: de Swiet et al.a thorough autopsy w
Page 134 and 135: Oates, CantwellChapter 11: Deaths f
Page 136 and 137: Oates, CantwellTable 11.1. Timing o
Page 138 and 139: Oates, CantwellTable 11.5. Maternal
Page 140 and 141: Oates, CantwellChild protection iss
Page 142 and 143: Oates, CantwellAll women who are su
Page 144 and 145: Oates, Cantwell4 Kendel RE, Chalmer
Page 146 and 147: Lewismaternal mortality rates or ra
Page 148 and 149:
Annex 12.1. Domestic abuseAnnex 12.
Page 150 and 151:
Annex 12.1. Domestic abuseshe could
Page 152 and 153:
Garrod et al.supportive but challen
Page 154 and 155:
Garrod et al.• Culture and system
Page 156 and 157:
Garrod et al.the second stage and s
Page 158 and 159:
Garrod et al.through the still heal
Page 160 and 161:
ShakespeareChapter 14: General prac
Page 162 and 163:
Shakespeareemergency caesarean sect
Page 164 and 165:
ShakespeareCardiac diseaseDeaths fr
Page 166 and 167:
Shakespearereduce the risks to the
Page 168 and 169:
ShakespeareManaging a maternal deat
Page 170 and 171:
Hulbertin the ED was of a high qual
Page 172 and 173:
HulbertPre-eclampsia/eclampsia: lea
Page 174 and 175:
HulbertTransfersWhen the obstetric
Page 176 and 177:
Clutton-Brocksimply the case that s
Page 178 and 179:
Clutton-BrockDiagnosis of sepsisTak
Page 180 and 181:
Clutton-Brockpulseless electrical a
Page 182 and 183:
Clutton-BrockImprovement Scotland (
Page 184 and 185:
Lucas, Millward-Sadler95 mmHg. This
Page 186 and 187:
Lucas, Millward-Sadleran agreed mai
Page 188 and 189:
Annex 17.1. The main clinico-tholog
Page 190 and 191:
MillerAppendix 1: The method of Enq
Page 192 and 193:
MillerDatanotificationNotificationR
Page 194 and 195:
Knight• investigating different m
Page 196 and 197:
Knightbaseline incidence against wh
Page 198 and 199:
LennoxAppendix 2B: Summary of Scott
Page 200 and 201:
LennoxEvidence of effective managem
Page 202 and 203:
Appendix 3: Contributors to the Mat
Page 204 and 205:
Appendix 3: Contributors to the Mat
show all

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

Create successful ePaper yourself

Delete template?

Save as template?