Ethnicity and late booking in an urban obstetric population

Abstract

A recent findingof theConfidential EnquiryonMaternal andChild Health (CEMACH)1was thatmaternalmortality is associatedwith risk factors such as increased maternal age (>35 years), obesity [body mass index (BMI)> 30], late booking and social disadvantage. In the 3-year period from April 2002, there were 10 maternal deaths at NorthwickParkHospital (NPH);due to thisexcessivenumber, theunit was investigated by the Health Care Commision2 and placed under ‘special measures’ by the Department of Health until October 2006. The terms of reference of the Health Care Commission report and subsequent measures were directed to practice and governance rather than investigating the incidence of risk factors. Since then, a review of maternity services has stated that a high number of high-risk pregnancies were booked at NPH. However, this risk relates to fetomaternal rather than maternal risk, and is heavily weighted towards past obstetric history. A computerized database (Ciconia Maternity Information System CMiS; H-D Clinical, Bishop’s Stortford, UK) was used to assess the prevalence of the risk factors identified by CEMACH in the study population. Obstetric booking data for the first 2 years following the lifting of special measures were examined. At NPH, all mothers are entered on the database at booking and the delivery is entered as part of the birth notification process to the Office of Population Statistics. Baseline data include maternal age, weight, BMI and gestational age at booking. The CMiS Ethnic Group categories are collected for the mother, and based on the categories used in the 2001 Census and the National Health Service (NHS) Data Dictionary from 1 April 2001 (see DSC Notice 02/2001).4 In the 2-year period under evaluation, 10,255 mothers delivered at NPH. All births were registered on the database; data for age and BMI at booking were 98% complete, while data for ethnicity and gestational age at booking were 96% complete.