Psychiatric causes of maternal deaths: Lessons from the Confidential Enquiries into Maternal Deaths

2014 ◽  
Author(s):  
Margaret R. Oates
Keyword(s):  
Maternal Death ◽  
Cardiac Disease ◽  
Maternity Care ◽  
Marked Reduction ◽  
Blood Transfusions ◽  
Maternal Deaths ◽  
Illegal Abortion ◽  
The Uk ◽  
The 19Th Century ◽  
In Pregnancy

The UK Confidential Enquiries into Maternal Deaths, published triennially, are over 50 years old. Its forebears are even older; enquiries into maternal deaths began early in the 19th century in Scotland. In the 20th century the numbers of women dying from childbirth has steadily declined, influenced by many factors, including improved public health and maternity care, smaller family size, blood transfusions, and antibiotics, to name but a few. The introduction of the Abortion Act in 1967 was followed by a marked reduction of deaths in pregnancy from the consequences of illegal abortion. The rate and causes of maternal death have always been influenced by changes in reproductive epidemiology and technology, and continue to be so. Maternal deaths in pregnancy and in the 6 weeks following delivery are required to be reported to the Coroner, if directly related to childbirth. However, there are other causes of maternal death due to conditions exacerbated by pregnancy: for example, diabetes, cardiac disease, epilepsy. These are referred to as indirect deaths. Women who die from conditions unrelated to pregnancy or childbirth are counted and described as coincidental deaths. Over the years as the direct causes of maternal death have fallen, the indirect causes of maternal death have achieved more prominence and case ascertainment has improved. Improvements in medical care and in particular intensive care have resulted in some women developing their fatal condition within 6 weeks of childbirth, only to die beyond it. For this reason, the UK Enquiry extended their period of surveillance beyond 6 weeks to include late maternal deaths, both a small number of late direct deaths and a larger number of late indirect deaths. Suicide in pregnancy and following delivery has always been included in the Enquiries. However, prior to 1994 the cases were not separately analysed and were included in the group of late Coincidental Deaths (i.e. not thought to be related to pregnancy or childbirth). The 1994–1996 Enquiry, under the Directorship and Editorship of Dr Gwyneth Lewis and Professor James O’Drife, heralded a change in presentation of the Enquiry.

scholarly journals Obstetric medical care and training in the United Kingdom

2016 ◽  
Vol 10 (1) ◽  
pp. 40-42 ◽  
Author(s):  
Adam D Jakes ◽  
Ingrid Watt-Coote ◽  
Matthew Coleman ◽  
Catherine Nelson-Piercy
Keyword(s):  
Core Curriculum ◽  
Contributory Factor ◽  
Medical Conditions ◽  
Medical Problems ◽  
Maternal Deaths ◽  
Obstetric Medicine ◽  
Physician Role ◽  
The Uk ◽  
Maternal Medicine ◽  
In Pregnancy

The UK confidential enquiry into maternal deaths identified poor management of medical problems in pregnancy to be a contributory factor to a large proportion of indirect maternal deaths. Maternal (obstetric) medicine is an exciting subspecialty that encompasses caring for both women with pre-existing medical conditions who become pregnant, as well as those who develop medical conditions in pregnancy. Obstetrics and gynaecology trainees have some exposure to maternal medicine through their core curriculum and can then complete an advanced training skills module, subspecialise in maternal–fetal medicine or take time out to complete the Royal College of Physicians membership examination. Physician training has limited exposure to medical problems in pregnancy and has therefore prompted expansion of the obstetric physician role to ensure physicians with adequate expertise attend joint physician–obstetrician clinics. This article describes the role of an obstetric physician in the UK and the different career pathways available to physicians and obstetricians interested in maternal medicine.

scholarly journals Trends in maternal deaths from epilepsy in the United Kingdom: a 30-year retrospective review

2014 ◽  
Vol 7 (4) ◽  
pp. 160-164 ◽  
Author(s):  
Dipanwita Kapoor ◽  
Suzanne Wallace
Keyword(s):  
United Kingdom ◽  
Maternal Mortality ◽  
Maternal Death ◽  
Retrospective Review ◽  
Neurological Diseases ◽  
Clinical Care ◽  
Confidential Enquiry ◽  
Unexpected Death ◽  
Maternal Deaths ◽  
The Uk

Objective Neurological diseases remain the second most common cause of maternal mortality from indirect causes, according to the last United Kingdom confidential enquiry into maternal death. The maternal mortality rate from epilepsy is reported as 0.61 per 100,000 maternities. The aim of this study was to analyse the trends and causes of maternal death from epilepsy in the UK over the last 30 years. Information on sub-standard care associated with fatalities was also consolidated to inform guidance and clinical care by obstetricians and physicians caring for pregnant women with epilepsy. Study design A retrospective review of 10 triennial confidential enquiry into maternal death reports (1979–2008) was performed, encompassing 21,514,457 maternities. Late and coincidental deaths were not included in the analyses. Results Between 1979 and 2008, there were 92 maternal deaths from epilepsy. The proportion of total maternal deaths from epilepsy over 30 years is 3.7% (95% CI 3.0–4.5), which showed an increasing trend. Sudden unexpected death in epilepsy remains the single greatest cause of maternal death from epilepsy followed by aspiration of gastric contents during seizures and drowning during bathing. Conclusion All women with epilepsy should be looked after by specialist combined obstetric and medical or neurological teams in pregnancy to improve maternal and fetal outcomes.

Confidential Enquiries into Maternal Deaths

2020 ◽  
pp. 29-44
Author(s):  
Nuala Lucas ◽  
James Bamber
Keyword(s):  
Maternal Death ◽  
Time Lag ◽  
Developing Nations ◽  
Lessons Learned ◽  
Maternal Deaths ◽  
Healthcare Settings ◽  
The World ◽  
Emerging Patterns ◽  
The Uk ◽  
Causes Of Deaths

The Confidential Enquiries into Maternal Deaths is the longest running audit of maternal mortality in the world. From its inception in 1952 to 2011, triennial reports have been published on the direct and indirect causes of maternal death, with salutatory messages from the care delivered to these mothers. Since 2011, the report has been published annually, to facilitate a more rapid response to emerging patterns of disease and prevent a time-lag in dissemination and learning from cases. The historical trend in causes of deaths is well-described, with mortality figures for the UK and the current themes in lessons learned. Despite this representing UK demographics and healthcare, many of the lessons learnt are applicable in healthcare settings around the world, including developing nations.

Acquired heart disease

2016 ◽  
Author(s):  
Linzi Peacock ◽  
Rachel Hignett
Keyword(s):  
Heart Disease ◽  
Maternal Death ◽  
Intensive Therapy ◽  
World Health ◽  
Early Assessment ◽  
Maternal Deaths ◽  
Aortic Pathology ◽  
Acquired Heart Disease ◽  
Heart Disease In Pregnancy ◽  
In Pregnancy

Heart disease in pregnancy is a leading cause of maternal death worldwide. In the United Kingdom and United States, heart disease in pregnancy is the commonest cause of maternal death. In Europe, over 1% of maternal deaths are attributable to structural heart disease. In addition, heart disease in pregnancy is a significant cause of severe maternal and fetal morbidity. Whilst the vast majority of women with heart disease in pregnancy have underlying congenital heart disease, most maternal deaths are due to acquired heart disease (AHD). As the risk factors for AHD become ever more prevalent, the expectation is that disease burden from AHD in pregnancy will also increase. Women with AHD benefit from preconception or early assessment in pregnancy by a multidisciplinary team including obstetricians, cardiologists, and obstetric anaesthetists. Risk assessment using the modified World Health Organization classification of cardiac disease in pregnancy will inform frequency of review in pregnancy. A detailed plan for delivery should be agreed in the third trimester. Where possible, a vaginal delivery is advised: caesarean delivery is reserved for women with obstetric indications or with specific severe underlying cardiac conditions. Slow incremental epidural analgesia is usually recommended to reduce the cardiorespiratory work of labour and an assisted second-stage delivery will limit exertion due to pushing. Neuraxial anaesthesia for operative delivery is becoming a more familiar approach and techniques such as low-dose spinal component combined spinal–epidural or slow incremental epidural top-up maximize haemodynamic stability. Invasive monitoring is often beneficial. Post-delivery care is safely delivered in a high dependency or intensive therapy setting. This chapter looks at the general principles of management of women with AHD, and then examines in detail ischaemic heart disease, arrhythmias, cardiac transplantation, aortic pathology and aortic dissection, cardiomyopathy, valvular heart disease, and infective endocarditis.

Analysis of preventability of hypertensive disorder in pregnancy-related maternal death using the nationwide registration system of maternal deaths in Japan

2018 ◽  
Vol 32 (20) ◽  
pp. 3420-3426 ◽  
Author(s):  
Shinji Katsuragi ◽  
Hiroaki Tanaka ◽  
Junichi Hasegawa ◽  
Masamitsu Nakamura ◽  
Naohiro Kanayama ◽  
...  
Keyword(s):  
Maternal Death ◽  
Hypertensive Disorder ◽  
Maternal Deaths ◽  
Registration System ◽  
In Pregnancy

scholarly journals Assessing the new ICD-MM classification for assigning the cause of maternal mortality at a tertiary centre in Western India: a retrospective study

2019 ◽  
Vol 8 (9) ◽  
pp. 3629
Author(s):  
Tosha M. Sheth ◽  
Palak P. Vaishnav ◽  
Nandita K. Maitra
Keyword(s):  
Cause Of Death ◽  
Maternal Death ◽  
Health Centre ◽  
Healthcare Providers ◽  
World Health Organisation ◽  
World Health ◽  
Western India ◽  
Maternal Deaths ◽  
In Pregnancy

Background: The World Health Organisation (WHO) in 2012 introduced the 10th revision of International Classification of Disease (ICD 10) to deaths in pregnancy, labour and puerperium (ICD-MM) for consistent collection, analysis and interpretation of information on maternal deaths. The proper use of this classification requires training to avoid heterogeneity and error in the classification of maternal deaths.Methods: We analysed the Maternal Death Review (MDR) forms of 295 deaths over a period of 5 years (January 2014 to December 2018 inclusive) occurring at a tertiary health centre in Western India. The ICD-MM classification was used to reassign the cause of death.Results: There were 295 deaths in women during pregnancy, childbirth and puerperium during the 5 year period. Of these there were 294 maternal deaths and one coincidental death. There were 173 deaths of the direct type (58.84%), 105 deaths of the indirect type (35.71%) and 16 deaths (5.44%) of the unspecified type. Obstetric haemorrhage was  the highest contributor to direct deaths (23.8%) and anaemia contributed to the maximum deaths from indirect causes (13.6%) followed by liver diseases in pregnancy (10.54%).Unanticipated complications of management accounted for 2% of the total deaths. There was considerable inaccuracy in assigning cause of death by consultants who were untrained in the use of the ICD-MM classification.Conclusions: ICD-MM classification promotes an accurate assignment of the cause of death. Training of healthcare providers performing maternal death reviews in the use of this classification is essential to identify accurate underlying cause of death and contributory conditions. 

Maternal critical care

2019 ◽  
pp. 569-577
Author(s):  
Carl Waldmann ◽  
Andrew Rhodes ◽  
Neil Soni ◽  
Jonathan Handy
Keyword(s):  
Critical Care ◽  
Cardiac Disease ◽  
Maternity Care ◽  
Maternal Age ◽  
Maternal Morbidity ◽  
Neurological Emergencies ◽  
Obstetric Haemorrhage ◽  
The World ◽  
Obstetric Emergencies ◽  
The Uk

The UK maternal mortality rate is one of the lowest in the world, at 9.8/100 000 maternities. However, for every maternal death there are at least 70 women who develop severe maternal morbidity, and this rate is rising with increasing body mass index, maternal age, and pre-existing disease. The commonest ‘direct’ cause of death because of pregnancy is thrombosis, and ‘indirect’ cause from a pre-existing problem is cardiovascular disease. The confidential mortality reports and recommendations on mortality MBRRACE-UK have resulted in major improvements in common obstetric problems such as venous thromboebolism, pre-eclampsia, and haemorrhage. Nowadays focus is also directed to examining causes of and improving management of morbidity (as opposed to mortality), often from other disorders such as infection, cardiac, and respiratory disease, resulting in the need for critical care. This chapter discusses maternal critical care, enhanced maternity care, and includes discussion on common conditions causing illness in pregnancy, obstetric emergencies, and reviews and guidelines. There are sections on venous thromboembolism, pre-eclampsia, massive obstetric haemorrhage, obstetric sepsis, cardiac disease, neurological emergencies, liver failure, diabetic emergencies, amniotic fluid embolism, and complications of anaesthesia.

scholarly journals Rhetorical uses of precise numbers and semi-magical round numbers in political discourse about COVID-19: Examples from the government of the United Kingdom

2021 ◽  
pp. 095792652110131
Author(s):  
Michael Billig
Keyword(s):  
19Th Century ◽  
British Government ◽  
Political Incentives ◽  
The United Kingdom ◽  
Round Numbers ◽  
Magical Power ◽  
Uk Government ◽  
The Government ◽  
The Uk ◽  
The 19Th Century

This paper examines how the British government has used statistics about COVID-19 for political ends. A distinction is made between precise and round numbers. Historically, using round numbers to estimate the spread of disease gave way in the 19th century to the sort precise, but not necessarily accurate, statistics that are now being used to record COVID-19. However, round numbers have continued to exert rhetorical, ‘semi-magical’ power by simultaneously conveying both quantity and quality. This is demonstrated in examples from the British government’s claims about COVID-19. The paper illustrates how senior members of the UK government use ‘good’ round numbers to frame their COVID-19 goals and to announce apparent achievements. These round numbers can provide political incentives to manipulate the production of precise number; again examples from the UK government are given.

IMPROVEMENT AND ADAPTATION OF THE FAYOUMI CHICKEN

1994 ◽  
Vol 14 ◽  
pp. 33-39 ◽  
Author(s):  
M. A. Hossaryl ◽  
E. S. E. Galal
Keyword(s):  
Genetic Material ◽  
Research Station ◽  
Cooperative Society ◽  
Tropical Conditions ◽  
The Usa ◽  
The Creation ◽  
The Uk ◽  
The 19Th Century ◽  
Actual Prevalence

SUMMARYThe Fayoumi (Oasis/Province of Fayotimi) or Ramadi (village of Dar-el-Ramad) breed of chicken is said to have been introduced into this area in the early part of the 19th century; phenotypically it recalls the Silver Campine from which it is reputed to descend. A hardy and well adapted breed it was saved through the creation of the Fayoumi Poultry Research Station in 194é, which also assured an active improvement policy of the breed. The creation in 1958 of the Fayoumi Poultry Cooperative Society further strengthened the conservation of the breed and its use through distribution of genetic material to farmers and smallholders of the Fayoumi province. Since the early é0's the breed is reported to have been successfully introduced to countries as different as the UK and the USA, Vietn@ Iraq, Pakistan and India. Its adaptability and resistance to the problems of xyrotherrnic tropical and sub-tropical conditions is confirmed by its actual prevalence in Southern Egypt.

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