MATERNITY SERVICE PROVISION

Initiative to Develop Maternity Service Provision for Women Cared For By the Community Team



Initiative to Develop Maternity Service Provision for Women Cared For By the Community Team

Introduction

Maternity care in United Kingdom is among the safest in the world, with low maternal and perinatal mortality rates compared with other nations in the Organisation for Economic Co-operation and Development (OECD).

The aim of Centre for Maternal and Child Enquiries is to improve the health of mothers, babies and children by carrying out confidential enquires and related work on a nationwide basis and by widely disseminating their findings and recommendations. The enquiries specifically designed to ensure that women and babies that die in childbirth are not reported upon just as statistics, they look beyond the numbers and have been very successful in uncovering, what may have finally been hidden, truths about maternal deaths. Maternal sepsis can be a severe complication of pregnancy or birth, which if untreated, can rapidly progress along a continuum of severity to septicaemic shock and eventually death.

In the UK, the incidence of fatal maternal sepsis has increased over the last two decades.

In the late 1980's the maternal mortality rate (MMR) due to sepsis was 0.4/100,000 maternities, while in the period from 2006-2008 the MMR increased to 1.13/100,000. This places sepsis as the leading cause of direct maternal death, surpassing hypertensive disorders. Underlying each maternal death is a much larger number of cases of morbidity during pregnancy and puerperium. Given the recent increase in maternal deaths and morbidity incidence in the general population due to sepsis, an understanding of the risk factors in the UK of obstetric sepsis morbidity before death occurs is needed to better target potential points of clinical intervention. Establishing this epidemiology is vital to the prevention of poor outcomes for mothers and their infants.

While there are several well-established risk factors for maternal sepsis including caesarean section and anaemia, there has been no national-level study of the incidence or risk factors for this complication in the UK. From 2003-2005, 71% of mothers who died directly by sepsis in the UK were found to have had substandard care (mainly delay in diagnosis), 33% were obese, and 48% has caesarean sections, all of whom were either overweight or obese2.

The eighth Report of the Confidential Enquiries into Maternal Deaths in the UK investigates the deaths of 261 women who died in the triennium 2006-08, from causes directly or indirectly related to pregnancy. The full Report is available for purchase or download from the Centre for Maternal and Child Enquiries (CMACE; www.cmace. org.uk). Although every maternal death is a tragedy, particularly where avoidable factors were identified by the Enquiry process, the overall picture is encouraging. The maternal death rate in the UK continues to decline despite increasing pressures on maternity services and a changing maternal population. For the first time there has been a reduction in the inequalities gap between women living in different socio-economic circumstances, and timely production of guidelines and tools appears to have helped clinical staff ...