Medical disorders complicating pregnancy

Abstract

There were 378 deaths reported in the most recent Confidential Enquiry into Maternal Deaths which covers the years 1997 to 1999 and was published in 2001. Disease patterns have changed over recent Enquiries with direct causes of death decreasing (except, sepsis which is increasing) and there has been an increase in the numbers of indirect deaths. Cardiac disease and thromboembolic disease are now jointly the most common causes of maternal death. Deaths from thromboembolic disease have fallen since the last Confidential Enquiry. The RCOG now has two guidelines on this subject: Thromboprophylaxis during pregnancy, labour and following spontaneous vaginal delivery (January 2004) and the 1995 Guideline on thromboprophylaxis following caesarean section. As more women with cardiac disease are becoming pregnant, knowledge of the physiological haematological adaptations to pregnancy and delivery is important because these women may be placed at serious risk. These women should have pre-pregnancy counselling where possible and in some the advice will be against contemplating or continuing with a pregnancy. The prevalence of asthma in women of childbearing age is increasing and asthma is the most common pre-existing medical condition encountered in pregnancy. Management should include reassurance regarding the safety of medications used to control asthma. The biggest danger to the mother and the fetus comes from poorly controlled or under-treated disease. In pregnancies complicated by epilepsy about 20% of women experience an increased seizure frequency and those with poorly controlled epilepsy are more likely to deteriorate. Most deaths are from aspiration but epileptic seizures may be fatal in themselves. Pre-pregnancy counselling is important as is regular monitoring of compliance and seizure control during the pregnancy, intra- and postpartum.