Medical experts call for action on number of pregnancy-related deaths

Published on Tuesday 9 August 2011 18:04

Doctors are calling for action over the "worrying" number of women in the UK dying in pregnancy and shortly after delivery.

A rise in the number of "high risk" pregnancies, including older and obese mothers, means women can suffer a complex mix of health problems, they said.

Nevertheless, most deaths are now caused by preventable or treatable medical conditions, and doctors, including GPs, need to be on their guard, they added.

Writing in the British Medical Journal (BMJ), Catherine Nelson-Piercy, professor of obstetric medicine at King's College London, and colleagues called for an increase in the number of obstetric physicians and better training for GPs.

While the overall number of deaths has decreased since the 1950s, there has been a rise in the number dying from conditions not directly caused by pregnancy - which, the report said, represents a "worrying trend".

The leading cause of maternal death is heart disease while the second is neurological disease.

Most of these deaths are associated with substandard care and "in one third of cases this is classified as major substandard care, where different care might have prevented death of the mother," they added.

"These failings require urgent attention."

In March, a report from the Centre for Maternal and Child Enquiries revealed that 261 women in the UK died from conditions directly or indirectly related to pregnancy for the three years from 2006 to 2008.

Some 107 mothers died of conditions that could only have arisen if they had been pregnant (direct deaths), while 154 died of indirect causes, including infections and underlying health problems.

The research said some women die every year from treatable conditions such as epilepsy, diabetes and asthma.

A failure to diagnose these women properly, investigate their symptoms and treat them results in substandard care, the experts said.

"Obstetricians and midwives alone cannot reduce indirect maternal deaths - they need support from physicians and general practitioners," they added.

"But many doctors are unfamiliar with the interaction between pregnancy and medical disease, the safety of radiological investigations in pregnancy, and the risk-benefit ratio for the use of different drugs in pregnancy.

"During the three years that the current report is based on (2006-8), one woman died from asthma after her general practitioner advised her to stop taking oral prednisolone."The team highlighted how more women with complex health problems are now getting pregnant.

"Increasing numbers of women with often complex medical conditions are now becoming pregnant or seeking fertility treatment," it said.

"Women are delaying childbearing until later in life, and the menopause is no longer a barrier to pregnancy. Older women are more likely to be obese, have hypertension, or be predisposed to gestational diabetes and thromboembolism."

The team proposes increasing the number of obstetric physicians and insisting GPs and other doctors are trained in obstetrics "as already happens in the US, Canada, Australia and New Zealand".

This could help them look for signs of possible underlying problems, such as breathlessness, headache and abdominal pain.

The Royal College of Obstetricians and Gynaecologists welcomed the research and said more resources were needed to meet the demands posed by an increasing birth rate and more complex health issues.