Preventing maternal deaths – how the anesthetist
**Note that this presentation is made at the Euroanaesthesia congress in Milan, June 4-6. Please credit congress if you use this story**
In a session at this year’s Euroanaesthesia, obstetric anesthesia expert Dr Nuala Lucas (Northwick Park Hospital, London, UK) will examine key messages for the practice of anesthesia from UK reports on maternal mortality that are produced each year to provide solid information on the causes of maternal mortality. deaths to promote learning and further reduce preventable maternal mortality in the UK and beyond.
In the latest of these reports covering the period 2017-2019, a total of 191 women died during or up to six weeks after termination of pregnancy from causes associated with their pregnancy, out of 2,173,810 women who gave birth in the Kingdom. -United. This translated to a rate of 8.8 women per 100,000 who die during pregnancy or up to six weeks after childbirth or the end of pregnancy – a rate similar to that seen in 2010-12, nearly from a decade earlier.
Data regarding ethnicity showed an alarming disparity – while the maternal mortality rate was 7 per 100,000 for white women, for Asian women it was 12 per 100,000; for mixed-race women 15 per 100,000, and for black women a staggering 32 per 100,000 – more than four times the rate for white women. Similarly, the poorest 20% of pregnant women, with a maternal mortality ratio of 14, were twice as likely to die as those in the wealthiest 20% (maternal mortality ratio of 7).
The UK Maternal Mortality Survey Program is led by Professor Marian Knight of the National Perinatal Epidemiology Unit at the University of Oxford and supported by clinicians from several disciplines in maternity care. Professor Knight said: ”Our latest report is a reminder of the urgent action needed to reduce inequalities in maternity care that exist because of a woman’s ethnicity and socio-economic status. This will be crucial to ensure a reduction in maternal deaths in the future.”
The report shows that heart disease remains the leading cause of death among women during or just after pregnancy, followed by epilepsy and stroke. Sepsis, thrombosis and thromboembolism (blood clots) remain important causes of maternal death during or up to six weeks after pregnancy ends. The maternal mortality rate due to pre-eclampsia and eclampsia continues to be low, but is higher than the lowest rate recorded in 2012-2014. Cancer is the most common cause of death in women between six weeks and a year after the end of pregnancy. Maternal suicide remains the leading direct (pregnancy-related) cause of death in the first year after pregnancy.
Dr Lucas says: “Although some of these events are beyond the remit of maternal anesthesia teams, such as the tragedy of cancer during or just after pregnancy, there is a lot we can do to further reduce maternal mortality in the UK. Even one preventable maternal death is unacceptable,” she explains.
Every 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 Gynecologists, together with the maternity team, ensuring that blood-thinning medication is prescribed if this is indicated. A major goal of improving outcomes is the use of primary and secondary prevention, especially risk recognition and stratification. This is essential for women at obviously higher risk of complications – those with heart disease.
Of course, not all complications can be avoided, and for some women, critical events like major postnatal bleeding (obstetric hemorrhage) will occur even in women without risk factors. Optimizing outcomes in these situations is highly dependent on ensuring “institutional readiness” in each maternity unit – the availability of staff and resources. Multidisciplinary training is now a mandatory requirement for NHS maternity units.
Finally, even when it seems that mother and baby are fine and everything has gone well, there may be sudden and unexpected deterioration of the mother in the recovery room. The use of maternal early warning scores to help detect acute deterioration has been a recommendation in the UK for several years. A new national Maternal Early Warning Score system is expected to be released later this year.
How relevant is the UK Maternal Mortality Report outside the UK? A United Nations Sustainable Development Goal is that by 2030 the global maternal mortality ratio (MMR) be reduced to less than 70:100,000 live births. To achieve an improvement in the quality of maternal health and a continuous reduction in MMR, it is necessary to understand the structures and processes that lead to maternal death. This approach, described by the World Health Organization as going “beyond the numbers”, can be undertaken by different methodologies depending on the healthcare environment and resources. MBRRACE-UK’s methodology, the oldest survey 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 agree that to achieve significant improvement in maternal mortality, it is necessary to address mortality from causes arising from existing disease aggravated by pregnancy. This will require greater emphasis on multidisciplinary planning and care delivery for women with existing disease. Obstetric anesthesia plays a vital role in many aspects of maternal care beyond the provision of anesthesia and analgesia. It shares responsibility for providing safe care, but is often underrepresented and underresourced in maternity care planning. Maternity anesthesia services must be adequately resourced, which is an essential action for policy makers and service planners.
Dr Nuala Lucas, Consultant Anesthetist and Co-Head of Anesthesia for MBBRACE-UK. Please email to arrange an interview. [email protected]
Professor Marian Knight, Professor of Maternal and Child Population Health, University of Oxford and MBRRACE-UK Maternal Mortality Inquiry Program Manager. Please email to arrange an interview. [email protected]
Alternate Contact at Euroanaesthesia Media Center: Tony Kirby. T) +44 7834 385827 E) [email protected]
Notes to Editors:
Dr. Lucas and Professor Knight declare no conflict of interest.
This release is based on an oral session 04S1 ‘Tackling maternal morbidity
and mortality at Euroanaesthesia 2022 in Milan. As this is an oral session, there is no abstract or poster. For more details on the UK report, published in 2021 and covering data from 2017 to 2019, see the links below:
Conflict of Interest Statement
The authors declare no conflict of interest
Disclaimer: AAAS and EurekAlert! are not responsible for the accuracy of press releases posted on EurekAlert! by contributing institutions or for the use of any information through the EurekAlert system.