A new rapid report, Learning from SARS-CoV-2-related and associated maternal deaths in the UK, suggests that pregnant and postpartum women with COVID-19 must receive coordinated care from physicians, obstetricians and midwives, and it must be recognised that perinatal mental health services are essential to maternity care even in the context of service changes due to COVID-19.
The new report was published today by the MBRRACE-UK Confidential Enquiry into Maternal Deaths led from the National Perinatal Epidemiology Unit, part of the Nuffield Department of Population Health, as part of the work of the Maternal, Newborn and Infant Clinical Outcome Review Programme.
Report authors reviewed the care of all pregnant and postnatal women who died with SARS-CoV-2 infection, from mental health-related causes or due to domestic violence between 1 March and 31 May this year. Ten women died with SARS-CoV-2 infection, eight from COVID-19 and two from other causes, four women died by suicide and two due to domestic violence.
During the three months covered by this report, over 160,000 women gave birth in the UK. The estimated SARS-CoV-2-associated maternal death rate, including all deaths of women with SARS-CoV-2 infection, is therefore around six per 100,000, maternal mortality due to suicide during or up to one year after pregnancy just over two per 100,000, and mortality due to homicide during or up to one year after pregnancy was one woman per 100,000 giving birth. Maternal death rates are usually calculated over a period of three years, thus these rates may not represent a significant difference in maternal death rates overall.
The majority of women who died from COVID-19 were from black or other minority ethnic groups and the authors emphasise that clinicians need to be aware of this increased risk and admit women early to ensure they receive the appropriate specialist care.
Professor Marian Knight, lead author of the report said ‘Women and their families need to know when they should seek urgent advice from their midwife or hospital, whether for worsening symptoms of COVID-19, mental health problems or domestic violence. It is important that this advice is communicated via an interpreter if necessary.
‘It needs to be recognised that perinatal mental health services as well as safeguarding for vulnerable women during and after pregnancy are essential. Planning for the future needs to ensure that essential maternity services, not solely those for women who contract COVID-19, remain in place during any potential second wave.’
Responding to the report, Chief Executive Officer of the Royal College of Midwives, Gill Walton, said ‘While this is a small study, it sadly indicates that many of the women who died from COVID-19 were from Black, Asian or ethnic minority backgrounds. This further emphasises the need for clear information to be given to these women so that they are better able to manage their health appropriately. Ensuring that those at higher risk are supported by a multi-disciplinary team – and that they see the same professionals over time - is key to tackling and improving outcomes for women with high risk pregnancies.’
Dr Edward Morris, President of the Royal College of Obstetricians and Gynaecologists, added ‘Every one of these deaths is a tragedy and our thoughts are with the families of the 16 women who died. It is crucial that we learn from the findings of this rapid report to help prevent future deaths.
‘Through our collaborative working with the MBRRACE team throughout the pandemic, the clinical recommendations have already been incorporated into our guidance for women and healthcare practitioners.
‘The guidance makes clear that pregnant women admitted to hospital with COVID-19 must have multi-disciplinary maternity care and states there should be a low threshold for review of pregnant Black, Asian, and minority ethnic women with COVID-19.’