Factors associated with maternal death from direct pregnancy complications: a UK national case–control study
01 Apr 2015-British Journal of Obstetrics and Gynaecology (Wiley-Blackwell)-Vol. 122, Iss: 5, pp 653-662
TL;DR: To investigate the factors associated with maternal death from direct pregnancy complications in the UK, a large number of patients were diagnosed with at least one maternal death-related complication during pregnancy.
About: This article is published in British Journal of Obstetrics and Gynaecology.The article was published on 2015-04-01 and is currently open access. It has received 81 citations till now. The article focuses on the topics: Maternal death & Prenatal care.
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01 Dec 2014
TL;DR: A welcome decrease in the overall rate of maternal death across the United Kingdom is shown, and a compelling message for the future has to be the importance of continuing the programme of vaccination against influenza in pregnancy in the UK and Ireland, working to maximise uptake and hence to ensure the authors prevent future influenza-related maternal deaths.
Abstract: This report continues the longest running programme of Confidential Enquiries into maternal deaths worldwide, and shows a welcome decrease in the overall rate of maternal death across the United Kingdom. In addition, it includes, for the first time, Confidential Enquiries into maternal deaths occurring in Ireland. The importance of this report lies in going “beyond the numbers” and recognising the death of every woman during or after pregnancy as a tragedy from which it is incumbent upon us, as health professionals, service planners or policymakers to learn lessons to improve future care. We must recognise that each woman included in this report leaves behind a bereaved family on whom the impact of her death will be lifelong. We owe it to those left behind to learn from the death of their mother, partner, daughter or friend and to make changes for the future to prevent other women from dying. The focus of this report is therefore clearly to the future, on the actions, small and large, that we as a community or an individual can make to continue to improve the quality of maternity care across the UK and Ireland. As such, it is also enhanced by the inclusion, for the first time, of Confidential Enquiries into the care of women with severe complications in pregnancy, but who survived, thus broadening the messages to improve care yet further. As always, the focus is not in attributing blame, but on improving future mothers’ care. Maternal deaths from genital tract sepsis have fallen significantly, but as this report shows, infections from all causes are an important cause of maternal death. This report spans the period of the influenza A/H1N1 pandemic, which severely affected pregnant women in particular. Some women died before immunisation was introduced, but a number of unvaccinated women died after the vaccination programme began, and, more recently, some women died from non-pandemic type seasonal influenza. The compelling message for the future has to be the importance of continuing the programme of vaccination against influenza in pregnancy in the UK and Ireland, working to maximise uptake and hence to ensure we prevent future influenza-related maternal deaths. At the same time, and as highlighted across many areas of the health service, early identification of pregnant and postpartum women whose medical condition is deteriorating and rapid actions to diagnose and treat pregnant and postpartum women with suspected sepsis will save lives. The importance of routine measurements such as pulse, temperature, respiratory rate and blood pressure in any ill pregnant women cannot be over-emphasised. Pregnant women can appear relatively well and yet become seriously ill with sepsis very quickly. Midwives, doctors and other health professionals need to “think sepsis” and implement sepsis bundles, including giving antibiotics within an hour of the diagnosis being suspected. The consistent year on year decrease in direct maternal deaths is evidence of commitment to and success in improving the care of women with obstetric complications in pregnancy throughout the health service. However, we still need to plan for the care of women with known co-existing medical complications in pregnancy. The majority of women who die during or after pregnancy in the UK and Ireland die from indirect causes, that is, from an exacerbation of their pre-existing diseases. Commitment to improve care for these women is needed across all professional organisations and groups, working alongside researchers to provide the evidence to ensure that we can provide the best care for women pre-pregnancy, during and after pregnancy. Throughout the report, areas of guidance where care can be improved have been clearly highlighted; an obvious area in which specific guidance is lacking is for the care of women with epilepsy in pregnancy. As Chief Medical and Nursing Officers we are committed to ensuring the development of such guidance and hence optimal care for mothers with epilepsy. This report would not be possible without the dedication and commitment of health professionals throughout the UK and Ireland. In particular, we would like to thank the dedicated assessors who review each individual woman’s death in order to identify actions to improve care in the future. This work is carried out without remuneration and in the assessors own time, because of their commitment to continuous quality improvement. It behoves health service provider organisations including hospitals, health boards, executives and trusts to continue to recognise the importance of this work at both a national and local level and allow assessors dedicated time for it to continue. We therefore welcome the findings in the report that will ultimately help improve outcomes for mothers and their families across the UK and Ireland.
595 citations
TL;DR: The current knowledge of COVID-19 in pregnancy and signpost areas for further research are explored to minimise its impact for women and their children.
Abstract: There are many unknowns for pregnant women during the coronavirus disease 2019 (COVID-19) pandemic. Clinical experience of pregnancies complicated with infection by other coronaviruses e.g., Severe Acute Respiratory Syndrome (SARS) and Middle Eastern Respiratory Syndrome, has led to pregnant woman being considered potentially vulnerable to severe SARS-CoV-2 infection. Physiological changes during pregnancy have a significant impact on the immune system, respiratory system, cardiovascular function, and coagulation. These may have positive or negative effects on COVID-19 disease progression. The impact of SARS-CoV-2 in pregnancy remains to be determined, and a concerted, global effort is required to determine the effects on implantation, fetal growth and development, labor, and neonatal health. Asymptomatic infection presents a further challenge regarding service provision, prevention, and management. Besides the direct impacts of the disease, a plethora of indirect consequences of the pandemic adversely affect maternal health, including reduced access to reproductive health services, increased mental health strain, and increased socioeconomic deprivation. In this review, we explore the current knowledge of COVID-19 in pregnancy and highlight areas for further research to minimize its impact for women and their children.
376 citations
16 Jan 2017
TL;DR: 1. 妊産褥婦のメンタルヘルス不調が考えられたときは、まず、緊 急の対応を要するか否かを見極める。
349 citations
TL;DR: The use of the MEWT tool, designed to address 4 of the most common causes of maternal morbidity, as well as provide assessment and management recommendations, resulted in significant improvement in mothers' morbidity.
117 citations
Cites background from "Factors associated with maternal de..."
...A number of reasons have been cited for the increase in poor maternal outcome, including the rise in the prevalence of comorbid conditions (obesity, hypertension, and diabetes) and the growing cesarean delivery rate.(1,2) State and national review of maternal deaths have suggested that significant improvement could have been made in the care provided to many of the women who died, and many of these cases were potentially preventable events....
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TL;DR: The prevalence of CKD in pregnancy is estimated to affect 3% of pregnant women in high-income countries, (Piccoli et al., 2018, #13860) which equates to between 15,000–20,000 pregnancies per year in England.
Abstract: Background
Chronic kidney disease (CKD) is estimated to affect 3% of pregnant women in high-income countries, (Piccoli et al., 2018, #13860) which equates to between 15,000–20,000 pregnancies per year in England. The prevalence of CKD in pregnancy is predicted to rise in the future due to increasing maternal age and obesity.
Although CKD is not a barrier to reproduction in most women, the risk of adverse pregnancy outcomes is increased in women with CKD including pre-eclampsia, fetal growth restriction, preterm delivery and accelerated loss of maternal renal function. CKD impacts on communication, decision-making, and the surveillance and management of women before, during, and after pregnancy.
Existing guidance on the management of CKD in pregnancy includes the UK Consensus Group on Pregnancy in Renal Disease (ISBN 978–1,107,124,073) and expert review. Neither Kidney Disease Outcomes Quality Initiative (KDOQI) or National Institute of Health and Care Excellence (NICE) have produced specific guidance on the management of renal disease in pregnancy. Published guidance containing information relevant to the care of women with CKD in pregnancy includes:
KDIGO 2017 Clinical Practice Guideline Update for the Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease–Mineral and Bone Disorder (CKD-MBD). UK Renal Association Commentary available at: BMC Nephrology 2018; 19: 240.
KDOQI Clinical Practice Guideline for Haemodialysis, 2015.
KDIGO Clinical Practice Guideline for the Evaluation and Management of CKD, 2012
KDIGO Clinical Practice Guideline for Glomerulonephritis, 2012
KDIGO Guideline for the Care of Kidney Transplant Recipients, 2009.
KDIGO Clinical Practice Guidelines for Nutrition in Chronic Renal Failure, 2008.
NICE: Intrapartum Care for Women with Existing Medical Conditions or Obstetric Complications and their Babies [NG121], 2019.
NICE: Urinary Tract Infection (Lower) Antimicrobial Prescribing [NG109], 2018
NICE: Urinary Tract Infection (Recurrent) Antimicrobial Prescribing [NG112], 2018.
NICE: Antenatal Care for Uncomplicated Pregnancies [CG62], 2008, updated 2017.
NICE: Vitamin D supplement use in specific population groups [PH56], 2017
NICE: Diabetes in Pregnancy: Management from Pre-conception to the Post-partum Period [NG3], 2015.
NICE: Antenatal and postnatal mental health: clinical management and service guidance [CG192], 2014, updated 2018.
NICE: Fertility: Assessment and Treatment for People with Fertility Problems, 2013.
NICE: Weight management before, during and after pregnancy [PH27], 2010 [additional data from 2017 surveillance available at: https://www.nice.org.uk/guidance/ph11/evidence/appendix-a-summary-of-evidence-from-surveillance-pdf-4671107966]
NICE: Hypertension in Pregnancy: Diagnosis and Management [CG107], 2011 (update awaited 2019).
UK Renal Association Clinical Practice Guidelines: Undernutrition in Chronic Kidney Disease, June 2019
RCOG: Thrombosis and Embolism During Pregnancy and the Puerperium, Reducing the Risk [Green-Top Guideline 37a], 2015.
MBBRACE Confidential Enquiry into Maternal Deaths and Morbidity: lessons learned to inform maternity care (triennial reports)
www.european-renal-best-practice.org/content/erbp-documents
95 citations
References
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TL;DR: For the first time there has been a reduction in the inequalities gap, with a significant decrease in maternal mortality rates among those living in the most deprived areas and those in the lowest socio-economic group.
2,288 citations
Nicholas J Kassebaum1, Amelia Bertozzi-Villa1, Megan Coggeshall1, Katya Anne Shackelford1 +349 more•Institutions (179)
TL;DR: Global rates of change suggest that only 16 countries will achieve the MDG 5 target by 2015, with evidence of continued acceleration in the MMR, and MMR was highest in the oldest age groups in both 1990 and 2013.
1,383 citations
TL;DR: An approach based on transformation and fractional polynomials which yields simple regression models with interpretable curves is proposed and shows that non-linear risk models fit the data better than linear models.
Abstract: Background The traditional method of analysing continuous or ordinal risk factors by categorization or linear models may be improved. Methods We propose an approach based on transformation and fractional polynomials which yields simple regression models with interpretable curves. We suggest a way of presenting the results from such models which involves tabulating the risks estimated from the model at convenient values of the risk factor. We discuss how to incorporate several continuous risk and confounding variables within a single model. The approach is exemplified with data from the Whitehall I study of British Civil Servants. We discuss the approach in relation to categorization and non-parametric regression models. Results We show that non-linear risk models fit the data better than linear models. We discuss the difficulties introduced by categorization and the advantages of the new approach. Conclusions Our approach based on fractional polynomials should be considered as an important alternative to the traditional approaches for the analysis of continuous variables in epidemiological studies.
956 citations
TL;DR: Eclampsia occurs in nearly one in 2000 maternities in the United Kingdom and is associated with high maternal morbidity and fatality in cases, and may present unheralded by warning signs.
Abstract: Objectives: To measure the incidence of eclampsia, establish how often it is preceded by signs of pre-eclampsia, document the morbidity associated with eclampsia, and determine the maternal case fatality rates. Design: A prospective, descriptive study of every case of eclampsia in the United Kingdom in 1992. Information was collected from reviews of hospital case notes and questionnaires to general practitioners. Setting: All 279 hospitals in the United Kingdom with a consultant obstetric unit. Results: Obstetricians and midwives notified 582 possible cases, and 383 were confirmed as eclampsia. The national incidence of eclampsia was 4.9/10000 maternities (95% confidence interval 4.5 to 5.4). Most convulsions occurred despite antenatal care (70%) and within one week of the woman9s last visit to a doctor or midwife (85%). Three quarters of first seizures occurred in hospital, of which 38% developed before both proteinuria and hypertension had been documented. Forty four per cent of cases occurred postpartum, more than a third (38%) antepartum, and the remainder (18%) intrapartum. Nearly one in 50 women (1.8%) died, and 35% of all women had at least one major complication. The rate of stillbirths and neonatal deaths was 22.2/1000 and 34.1/1000, respectively. Preterm eclampsia occurred more commonly antepartum and was associated with more maternal complications and fetuses that were small for gestational age, as well as with higher rates of stillbirth and neonatal mortality. Antepartum eclampsia, which was more likely to occur preterm, was associated with a higher rate of maternal complications and a higher neonatal mortality. Both factors (gestational prematurity and antepartum occurrence) contributed independently to the severity of the outcome. Conclusion: Eclampsia occurs in nearly one in 2000 maternities in the United Kingdom and is associated with high maternal morbidity and fatality in cases. It may present unheralded by warning signs. Preterm and antenatal eclampsia seem to be particularly severe.
902 citations