Maternal Mortality and Morbidity Flashcards
How frequent is cardiac arrest in pregnancy?
1:30,000
What is the maternal death rate?
1 in 10,000
How many deaths in MBBRACE 2010-12?
243: 165 indirect and 78 direct
26 coincidental
313 late
What do the RCOG estimate as rate of maternal collapse?
14-600 per 100,000 births
What is the mortality rate from pre-eclampsia?
0.38 per 100,000 maternities
What is the incidence and mortality rate of amniotic fluid embolism?
1-10 in 80,000 pregnancies
Mortality rate 20%
What is the biggest direct cause of maternal death in the UK?
VTE (pulmonary and cerebral)
26 deaths in 2010-12
What is the mortality rate from obstetric haemorrhage?
0.49 per 100,000
17 direct deaths
How frequent is PPH?
10-15% of all birthing women
How many deaths in 2010-2012 were due to cardiac disease?
54
What is the biggest cause of indirect maternal death in the UK?
Cardiac disease
How many deaths due to sepsis in 2010-12?
83
20 - genital tract sepsis (GAS in 12)
36 - influenza
9 - pneumococcal
What is the incidence and mortality rate of anaphylaxis in pregnancy in the UK?
1 in 30,000
mortality rate= 1%
How many deaths in the puerperium in 2010-12 were due to epilepsy or seizures?
14 (12 SUDEP)
How many deaths in 2010-12 were due to intracerebral or subarachnoid haemorrhage?
26
What is the incidence of uterine rupture?
0.02% of all pregnancies
2-3/1000 previous scar
What is the highest direct cause of maternal death?
Thrombosis
What is the maternal mortality rate from epilepsy?
0.4/100,000 maternities
What is the maternal mortality rate from CVA?
0.75/100,000 maternities
Mostly haemorrhagic - 50% SAH
What % of cardiac deaths were in overweight/obese women?
60%
How much more likely is VTE in obese women?
x9
How much more likely is GDM in obese women?
x3
How much more likely is hypertensive disease in obese women?
2-3x
How much more likely are stillbirth, PPH and CS in obese women?
x2
what was the maternal mortality rate in 2012-2014
8.5/100,000
how many women died (per 100,000) from heart disease in 2012-2014
2/100,000
what is the definition of maternal death?
Death of a women while pregnant or within 42 days of the end of the pregnancy from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes.
what is the definition of direct maternal death?
Deaths resulting from obstetric complications of the pregnant state (pregnancy, labour and puerperium), from interventions, omissions, incorrect treatment or from a chain of events resulting from any of the above.
what is the definition of INDIRECT maternal death?
Deaths resulting from previous existing disease, or disease that developed during pregnancy and which was not the result of direct obstetric causes, but which was aggravated by the physiological effects of pregnancy.
what is the definition of late maternal death?
Deaths occurring between 42 days and 1 year after the end of pregnancy that are the result of Direct or Indirect maternal causes.
what is the definition of a co-incidental maternal death?
Deaths from unrelated causes which happen to occur in pregnancy or the puerperium.
overall, in 2012-2014, how many women died during or within 42 days of end of pregnancy?
Of these, how many were co-incidental?
241.
41 were co-incidental deaths
in 2012-14, what were the leading causes of direct and indirect maternal deaths?
direct- VTE
indirect- cardiac disease
what is the leading cause of direct maternal deaths occurring within a year after the end of the pregnancy?
suicide
between 2009- 2014, how many women died from suicide?
111
after VTE, what were the next leading causes of direct maternal death in 2012-14?
amniotic fluid embolism, suicide
after cardiac disease, what was the next leading cause of indirect maternal death in 2012-14?
neurological causes
between 2012-14, how many women died between 6 weeks and 1 year after the end of the pregnancy?
323
13.79/100,000 maternities
of the women that died between 2012-14, what percentage were known to have pre-existing medical problems?
What % were known to have pre-existing mental health problems?
69%- medical
17%- mental health
what percentage of women who died btwn 2012-14 were obese? overweight?
1/3 were obese,
18% were overweight
among the women who died btwn 2012-14, how many were assessed as receiving “good care”, how many were assessed as “improvements in care could have made a difference to their outcome”
46%- good care
42%- improvements may have changed outcome
btwn 2013-15, how many pregnant women were identified as having a prosthetic heart valve?
58
3.7/100,000
what further investigations should be carried out if a woman dies from sudden cardiac arrest / aortic dissection with a morphologically normal heart
molecular studies at post-mortem with potential for family screening
of the women that died from cardiac disease, what was the commonest cause of death? What was the second commonest?
sudden arrhythmic cardiac death with a normal heart.
After this it was ischaemia
when a young person dies from aortic dissection, what should be the assumed diagnosis until proven otherwise?
inherited aortopathy
what is the incidence of acute coronary syndrome in pregnancy?
1.7/100,000
what is the mortality rate from pulmonary arterial hypertension?
20-30%
between 2012-14, how many women died from hypertensive disorders in pregnancy?
3
0.11/100,000 maternities
between 2009-14, how many women died at <24/40 (still pregnant, or after pregnancy ended at <24/40). What was the most common cause for early pregnancy deaths?
191.
common cause of early pregnancy deaths= ectopic
between 2009-2013, how many women died by suicide?
In total, how many died from mental health related causes?
101- death rate = 2.3/100,000
total 161 from mental health related causes. Death rate = 3.7/100,000
when should admission to a mother and baby unit be considered?
- rapidly changing mental state,
- suicidal ideation (violent nature)
- pervasive guilt or hopelessness
- significant estrangement from infant
- new/ persistent beliefs of inadequacy as a mother
- evidence of psychosis
between 2009-2013, how many women died between 6 weeks and 1 year after the pregnancy ended (late mat death)?
What was the biggest cause?
553 late maternal deaths.
biggest causes= cancer, followed by mental health problems
