The second report of the Confidential Enquiry into Maternal Deaths issued by the MBRRACE-UK collaboration is published today.
Led by the MBRRACE-UK team at the National Perinatal Epidemiology Unit in the Nuffield Department of Population Health at the University of Oxford this report details the findings of maternal mortality surveillance 2011 to 2013 in the UK and the lessons learned from the confidential enquiries into maternal deaths of women with mental health-related problems, substance misuse, cancer and blood clots and women who died by homicide.
Overall, the maternal mortality rate in the UK continues to fall, largely as a result of a reduction in deaths from ‘direct’ pregnancy causes. However the rate of deaths from ‘indirect’ causes has not reduced significantly. These are deaths from conditions not directly due to pregnancy, but existing conditions which are exacerbated by pregnancy, for example, women with heart problems. More of these deaths will need to be prevented in the future to reach the UK Government target of a 50% reduction in maternal deaths by 2030.
The care of more than 100 women who died by suicide during pregnancy or in the year after giving birth between 2009 and 2013 was reviewed in detail. One in eleven of the women who died during or up to six weeks after pregnancy died from mental health-related causes. However, almost a quarter of all maternal deaths between six weeks and a year after birth are related to mental health problems, and one in seven of the women who died in this period died by suicide. Although severe maternal mental illness is uncommon, it can develop very quickly in women after birth; the woman, her family and mainstream mental health services may not recognise this or move fast enough to take action.
The care for women with substance misuse problems and those living socially complex lives was also reviewed. The messages for future care echoed those for women with mental health problems, including the need for joined up multi-agency care to ensure that these women do not fall through the cracks between services. The report also contains messages for the future care of women with cancer and those at risk of blood clots, which is the primary cause of ‘direct’ maternal deaths.
Clear pointers for improving services and care by individual practitioners were identified and these are discussed in detail alongside the findings in the full report which is available to download.
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