Experts call for new measures to prevent maternal deaths

22 Jun 2016

More needs to be done to prevent maternal deaths from causes not directly linked to pregnancy and childbirth, say leading experts from the Royal College of Physicians and Surgeons of Glasgow and the Royal College of Obstetricians and Gynaecologists.

As part of a collaborative project led by leadership fellow Dr Rebecca Northridge, the Royal Colleges, in partnership with other medical organizations, have produced an animated video to help doctors assess unwell pregnant or post-partum women. The video, titled It’s better to ask: working together to prevent maternal mortality, aims to help reduce the number of maternal deaths in the UK.

One in every 10,000 pregnancies in the UK and Ireland results in the death of the mother. A 2014 MBRRACE-UK report into maternity care in the UK and Ireland, found that while 32% of these deaths were a direct consequence of complications during pregnancy such as pre-eclampsia or bleeding, 68% of deaths were the result of indirect medical and mental health problems. Indirect causes of maternal death during or shortly after pregnancy included cardiac conditions (23%), influenza and pneumonia (14%), deep vein thrombosis (11%), neurological conditions such as stroke or epilepsy (11%), and mental health problems resulting in suicide (9%). Three quarters of women who died had a previous history of medical or mental health problems. Since 2003-2005, the number of women dying from complications directly associated with pregnancy has almost halved from 6.24 per 100,000 to 3.49 per 100,000 in 2009-2011. However, the number of women who died following medical or mental health problems has not seen any significant decrease in the past 10 years (7.76 per 100,000 in 2000-2002, compared to 7.15 per 100,000 in 2009-2011).

The video is accompanied by a poster, titled Three P’s in a pod, which highlights the main causes of maternal death and provides doctors and midwives with advice for assessing pregnant and post-partum women who are feeling unwell. As such patients often present to non-obstetric acute medical services, the poster is being displayed in medical assessment centres and A&E departments across the UK, to serve as a reminder to such staff of the key potential danger areas.

The video advises doctors who are assessing pregnant and post-partum women to:

• Enhance inter-specialty communication and team working as they are crucial to preventing maternal death
• Never assume that symptoms are just caused by pregnancy
• Specifically search for cardiac causes of persistent breathlessness or chest pain
• “Red flag” pregnant and post-partum women who arrive at hospital complaining of ill health and make sure they are assessed by senior doctors and obstetricians before discharge, as pregnant women may look well but still become sick very quickly
• Have a low threshold for seeking expert help for pregnant and post-partum women and not be afraid to ask for help
• Never stop a women’s medication, such as anti-epileptic drugs, without seeking expert advice
• Provide an urgent phone referral for women who experience worsening epilepsy or a first seizure in pregnancy as it is a high risk condition in pregnancy
• Not withhold imaging that is regarded as safe (such as CXR, MRI and VQ scans)
• Commence antibiotics or anti virals promptly if there are signs of pneumonia or influenza
• Re-assess for blood clots at every encounter and prevent with anticoagulant medication
• Promptly make referrals to specialty departments by phone
• Familiarise themselves with their patient’s medical history including any pre-existing medical or mental health conditions
• Pay particular attention to women from complex social backgrounds when assessing for potential mental health problems

President of the Royal College of Physicians and Surgeons of Glasgow, Professor David Galloway, said: “I am very pleased that our College has contributed in advancing this vitally important message. Preventable death, wherever it occurs, is a tragedy. The strong messages which particularly relate to indirect causes of maternal mortality deserve wide publicity. We should aspire to the dramatic improvement that has already been achieved in the maternal death rate from complications directly related to pregnancy and delivery.”

Professor Hazel Scott, Honorary Secretary of the Royal College of Physicians and Surgeons of Glasgow said: “When patients who are pregnant or have been recently pregnant present unwell, all clinicians, whether they are physicians, specialists in A&E, or obstetricians and midwives, need to pick up the phone and work across disciplines to improve outcomes”

Chief Medical Officer for Scotland, Dr Catherine Calderwood, who met with the Presidents of the Royal College of Physicians and Surgeons of Glasgow and the Royal College of Physicians of Edinburgh to discuss the findings of the initial MBRRACE report in March 2015, said: “No one expects a pregnant or recently pregnant woman to die- yet this still happens every other day in the UK. Symptoms may be misinterpreted even by doctors and midwives because problems are rare. This brilliant 5 minute clip should be shown to as many healthcare professionals who see pregnant women as possible – it WILL save lives.”

The video will be launched at the Royal College of Obstetricians and Gynaecologists’ World Congress in Birmingham today by College President Dr David Richmond. Dr Richmond said: “While the number of women dying from complications directly associated with pregnancy has fallen, it is clear that we still face a challenge of further reducing the maternal death rate in the UK, particularly deaths caused by pre-existing conditions that are not directly related to pregnancy, such as mental health problems, epilepsy, heart disease or cancer.

The RCOG welcomes this new innovative resource, which encourages doctors and midwives to ‘red flag’ unwell pregnant women. Raising awareness of symptoms and providing healthcare professionals with advice for better assessment of pregnant and postpartum women who are feeling unwell, is crucial in the fight to prevent the unfortunate deaths that occur during and after pregnancy in the UK.”

President of the Royal College of Emergency Medicine, Dr Cliff Mann, said: “This video and poster together remind all medical staff of the unique health risks associated with pregnancy and the early post-partum period. It is to be hoped that this will be a further step to reducing preventable maternal deaths.”

Dr Northridge has also collaborated with NHS Health Education England to promote a free online tutorial, titled Medical problems in pregnancy, to help doctors improve their ability to assess unwell pregnant women quickly and effectively.

To watch the video and for more information visit http://rcp.sg/maternalhealth

Dr Rebecca Northridge is a senior trainee doctor in Obstetrics and Gynaecology and is currently working as a Clinical Leadership Fellow for the Royal College of Physicians and Surgeons of Glasgow.

The video and poster were produced in collaboration between the Royal College of Physicians and Surgeons of Glasgow, the Royal College of Obstetricians and Gynaecologists, with contribution from the Royal College of Physicians of Edinburgh, the Royal College of Physicians of London, MBRRACE (Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK), NHS Education for Scotland and the Royal College of Emergency Medicine.