Maternal mortality

Abstract

Worldwide, one maternal death occurs every minute. Most of these deaths are preventable. In the UK, the maternal mortality rate (MMR) fell from 400/100 000 in 1935 to 10/100 000 in 1982 because of a series of targeted initiatives, starting with antibiotics for puerperal sepsis. Confidential enquiries in their present form began in 1952 and the most recent triennial report, Why Mothers Die 1997–1999, was published in November 2001. It covers 106 direct and 136 indirect deaths, giving an MMR of 11.4/100 000. Risk factors include maternal age, parity, ethnicity and social class, and infer-tility, multiple pregnancy and IVF. The number of direct deaths is now the lowest ever. The leading cause of direct death was thromboembolism, which usually occurred in women with obvious risk factors such as obesity or a family history. Deaths from thromboembolism after Caesarean section fell sharply after the publication of an RCOG guideline on thromboprophylaxis, and a similar guideline is needed for women who have normal delivery. Deaths from hypertensive disease have fallen but 80% of cases had substandard care, such as failure to control high blood pressure. There were only seven deaths from haemorrhage—the lowest number ever—but in the past they have fallen to single figures only to rise again due to lessons being forgotten. Early pregnancy deaths have not fallen and ectopic pregnancy remains deceptive. The leading cause of indirect death is cardiac disease and it needs multidisciplinary management. Deaths from epilepsy and asthma also underline the need for better co-operation between physicians and obstetricians. A major concern of the latest report is psychiatric disease, as many cases of suicide have been identified which were not reported to the Enquiry. Women with a past history of serious mental illness are particularly at risk. Coincidental (formerly ‘fortuitous’) deaths include eight cases of murder, all perpetrated by the woman's partner or family. Domestic violence was recorded in 12% of the 378 cases in the Report.