PREGNANCY LOSS AND MATERNAL DEATH Flashcards
What is Better Births 2016?
A report published as a result of the National Maternity Review
It created the Maternity Transformstion model which seeks to bring together a wide range of organisations:
To transform the workforce
To share data and information
To harness digital technology
To reform the payment system
To promote good practice for safer care
To improve prevention
To improve access to perinatal mental health services
To transform neonatal critical care
To support local transformation
It increase choice and personalisation
Reports looking into problems with maternity care
Morecambe Bay 2015 - Furness Gen Hospital
Better Births 2016 - national
East Kent Hopsitals report 2020
The Ockenden Report 2022 - Shrewsbury and Telford
Summarise some of the key points from the Ockenden report?
Began as a review of 23 cases of concern but ended with 1486 families with 1592 clinical incidences, with the vast majority of these being between 2000 and 2019
Common themes identified - poor care, delay in escalation and a failure to recognise a change in risk category
Showed systematic failure to properly investigate and learn from adverse events
What is MBRRACE-UK?
Mothers and Babies: Reducing Risk through Audit and Confidential Enquiries (MBRRACE-UK) is the national programme responsible for conducting surveillance and investigating the causes of maternal deaths, stillbirths and infant deaths.
What are direct maternal deaths? (MBRRACE definition)
Deaths as a consequence to a disorder specific to pregnancy e.g. haemorrhage, pre-eclampsia, suicide
What are indirect maternal deaths? (MBRRACE definition)
Deaths resulting from previous existing disease, or diseases that developed during pregnancy, and which were not due to direct obstetric causes but aggravated by pregnancy
E.g. cardiac disease
What are coincidental maternal deaths? (MBRRACE definition)
Incidental or accidental deaths not due to pregnancy or aggravated by pregnancy
Eg. RTA
What are late maternal deaths? (MBRRACE definition)
Deaths occurring >42 days but <1 year after the end of pregnancy
Key messages from MBRRACE report?
229 women died during or up to 6 weeks after the end of pregnancy in 2018-2020. 24% higher than 2017-2019.
9 women from Covid.
27 of their babies died
A further 289 women died between 6 weeks and 1 year after end of pregnancy
86% of the deaths were in the postnatal period
Black women were 3.7x more likely to die than white women
Asian women 1.8x more likely to die than white woman
More women from deprived areas are dying
1 in 9 women who died had severe and multiple disadvantage
In 2020 women were 3x more likely to die by suicide during 6 weeks after the end of pregnancy compared to 2017-2019
Biggest causes of maternal mortality?
Suicide
Cardiac disease
Neurological conditions
Largest 2 causes of direct maternal deaths?
VTE
Sepsis
Biggest 2 causes of indirect maternal deaths?
Cardiac disease
Neurological conditions
What % of women who died as mentioned in the MBRRACE report had good care?
22%
40% if improvements in care had happen no difference to outcome
40% if improvements in care had happen there would have been a difference to outcome
What % of maternal deaths between 6 weeks and 1 year after pregnancy are caused by mental health-related causes?
40%
What is the most common cause of foetal death resulting in miscarriage?
Genetic abnormalities - 60%
