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‘Red flag’ unwell pregnant women to curb maternal deaths, clinicians told

Untreated underlying conditions or mental health issues often to blame

Caroline White

Wednesday, 22 June 2016

Doctors and midwives should ‘red flag’ pregnant women with underlying conditions or mental health issues, in an effort to curb maternal deaths, say leading experts from the Royal College of Physicians and Surgeons of Glasgow and the Royal College of Obstetricians and Gynaecologists.

One in every 10,000 pregnancies in the UK and Ireland results in the death of the mother. A 2014 MBRRACE-UK report into maternity care in the UK and Ireland, found that while around a third of these deaths were a direct consequence of complications during pregnancy such as pre-eclampsia or bleeding, two thirds were the result of indirect medical and mental health problems.

As part of a collaborative project, the Royal Colleges, in partnership with other medical organisations, have produced an animated video: It's better to ask: working together to prevent maternal mortality, to help doctors assess women who are unwell during pregnancy or shortly after giving birth.

Indirect causes of maternal death outlined in the MBRRACE-UK report included heart conditions (23%), influenza and pneumonia (14%), deep vein thrombosis (11%), neurological conditions such as stroke or epilepsy (11%), and mental health problems resulting in suicide (9%). Three quarters of women who died had a previous history of medical or mental health problems.

The number of women dying from complications directly associated with pregnancy almost halved from 6.24/100,000 in 2003-5 to 3.49/100,000 in 2009-11. However, the number of women dying with medical or mental health problems has not fallen significantly: 7.76/100,000 in 2000-02 compared to 7.15/100,000 in 2009-2011.

The video is accompanied by a poster, Three P’s in a pod, which highlights the main causes of maternal death and provides doctors and midwives with advice for assessing women who are feeling unwell during or just after their pregnancy.

As these patients often present to non-obstetric acute medical services, the poster is being displayed in medical assessment centres and A&E departments across the UK to remind staff of the key potential danger areas.

A free online tutorial, Medical problems in pregnancy, developed with Health Education England is also available to help doctors improve their ability to assess unwell pregnant women quickly and effectively.

Among its raft of recommendations, the video advises doctors who are assessing pregnant women and those who have just given birth to enhance inter-specialty communication and team work; to never assume that symptoms are just caused by pregnancy; and to specifically search for cardiac causes of persistent breathlessness or chest pain.

Clinicians should also ‘red flag’ those who arrive at hospital complaining of ill health and make sure they are assessed by senior doctors and obstetricians before discharge, as pregnant women may look well but can still become sick very quickly, it advises.

Furthermore, it says the threshold for seeking expert help for these women should be low, and clinicians should not be afraid to ask for help, nor should they ever stop a woman's medication, such as anti-epileptic drugs, without seeking expert advice.

President of the Royal College of Physicians and Surgeons of Glasgow, David Galloway said: “The strong messages which particularly relate to indirect causes of maternal mortality deserve wide publicity. We should aspire to the dramatic improvement that has already been achieved in the maternal death rate from complications directly related to pregnancy and delivery."

Chief Medical Officer for Scotland, Dr Catherine Calderwood, added: "No one expects a pregnant or recently pregnant woman to die - yet this still happens every other day in the UK. Symptoms may be misinterpreted even by doctors and midwives because problems are rare.”

President of the Royal College of Obstetricians and Gynaecologists, Dr David Richmond, commented: "While the number of women dying from complications directly associated with pregnancy has fallen, it is clear that we still face a challenge of further reducing the maternal death rate in the UK, particularly deaths caused by pre-existing conditions that are not directly related to pregnancy, such as mental health problems, epilepsy, heart disease or cancer. 

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