Urgent action must be taken to reduce the inequalities that exist in maternal mortality in the UK, a European conference has been told.
Dr Nuala Lucas, consultant anaesthetist specialising in obstetric anaesthesia and who works at Northwick Park Hospital, London, told delegates at the Euroanaesthesia Congress in Milan that the latest Maternal Mortality Reports, which are produced annually, showed “alarming disparities”.
The report, which covers 2017-19, showed 191 women died during or up to six weeks after the end of pregnancy, from causes associated with their pregnancy.
This translated to a mortality rate of 8.8 women per 100,000, similar to that in 2010-12. However, while the maternal mortality rate was 7 per 100,000 for white women, it rose to 12 per 100,000 for Asian women; 15 per 100,000 for mixed race women ; and 32 per 100,000 for Black women.
The report also found the most deprived 20% of pregnant women, with a maternal mortality rate of 14, were twice as likely to die as those in the most affluent 20%.
Professor Marian Knight, of the National Perinatal Epidemiology Unit at the University of Oxford and who leads the UK Maternal Mortality Enquiry programme, said: “Our latest report acts as a reminder of the urgent action required to reduce the inequalities in maternity care that exist due to a woman’s ethnicity and socioeconomic status. This will be crucial to ensure a reduction in maternal deaths in the future.”
Heart disease remains the leading cause of death among women during or just after pregnancy, followed by epilepsy and stroke. Sepsis and thrombosis and thromboembolism remain important causes of maternal death during or up to six weeks after the end of pregnancy.
<h3> One death is ‘unacceptable’ </h3>
The maternal death rate from preeclampsia and eclampsia is low but is higher than the lowest rate that was recorded, in 2012-14. Cancer is the most frequent cause of death for women between six weeks and a year after the end of pregnancy, while maternal suicide remains the leading direct pregnancy-related cause of death in the first year after pregnancy.
Dr Lucas says: “While some of these events are beyond the remit of the maternal anaesthesia teams, such as the tragedy of cancer during or just after pregnancy, there is much that we can do to further drive down maternal mortality in the UK. Even one preventable maternal death is unacceptable.”
Each pregnant woman in the UK should be assessed for the risk of blood clots using national guidelines produced by the Royal College of Obstetricians and Gynaecologists, with the maternity team ensuring anti-clotting medication is prescribed if this is indicated.
A major focus of improving outcomes is using primary and secondary prevention, particularly risk recognition and stratification. This is essential for women at an obviously higher risk of complications – those with heart disease.
However, optimising outcomes in critical events that occur in women with no risk factors, such as obstetric haemorrhage, relies heavily on ensuring ‘institutional preparedness’ in every maternity unit.
The use of maternal early warning scores to assist with detecting acute deterioration has been a recommendation in the UK for several years, but a new national maternal early warning score system is anticipated later this year.
A United Nations Sustainable Development Goal is that by 2030, the global maternal mortality ratio (MMR) will be under 70 per 100,000 live births.
To improve maternal health and continued reduction in MMR, it is necessary to understand the structures and processes that lead to a maternal death and this approach can be undertaken by different methodologies depending on the healthcare setting and resources.
The methodology of MBRRACE-UK, the longest running enquiry of its kind, provides an international benchmark, and many of the lessons highlighted in its reports are applicable in other healthcare settings.
Professor Knight and Dr Lucas say that to significantly improve the rate of maternal mortality, there is a need to address mortality due to causes arising from existing disease aggravated by pregnancy.
This will require increased emphasis on multidisciplinary planning and provision of care for women who have existing disease.
Obstetric anaesthesia has an integral role in many aspects of maternal care beyond the provision of anaesthesia and analgesia and has a shared responsibility for delivering safe care but is often under-represented and under-resourced in the planning of maternity care.
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