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Unwell pregnant women should be ‘red flagged’

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More needs to be done to prevent maternal deaths from causes not directly linked to pregnancy and childbirth, say leading clinical experts.

The Royal College of Physicians and Surgeons of Glasgow and the Royal College of Obstetricians and Gynaecologists, in partnership with other organisations, have produced an animated video to help assess unwell pregnant or post-partum women.

The video – titled It’s better to ask: working together to prevent maternal mortality – aims to help reduce the number of maternal deaths in the UK.

”This brilliant five-minute clip should be shown to as many healthcare professionals who see pregnant women as possible”

Catherine Calderwood

A 2014 MBRRACE-UK report into maternity care in the UK and Ireland – Saving Lives, Improving Mothers’ Care – found that 68% of deaths were the result of indirect medical and mental health problems.

Indirect causes of maternal death during or shortly after pregnancy included cardiac conditions, influenza and pneumonia, deep vein thrombosis, neurological conditions such as stroke or epilepsy, and mental health problems resulting in suicide.

Since 2003-05, the number of women who died from complications directly associated with pregnancy almost halved from 6.24 per 100,000 to 3.49 per 100,000 in 2009-11.

But the number of women who died following medical or mental health problems has not seen any significant decrease – 7.76 per 100,000 in 2000-02, compared to 7.15 per 100,000 in 2009-11.

The video is accompanied by a poster, titled Three Ps in a Pod, which highlights the main causes of maternal death and provides doctors and midwives with advice for assessing pregnant and post-partum women who are feeling unwell, said the college.

Because patients often present to non-obstetric acute medical services, it noted that the poster is being displayed in medical assessment centres and accident and emergency departments across the UK to “remind staff of the key potential danger areas”.

“This video and poster together remind all medical staff of the unique health risks associated with pregnancy”

Clifford Mann

Professor Hazel Scott, honorary secretary of the Royal College of Physicians and Surgeons of Glasgow, said: “When patients who are pregnant or have been recently pregnant present unwell, all clinicians, whether they are physicians, specialists in A&E, or obstetricians and midwives, need to pick up the phone and work across disciplines to improve outcomes.”

Chief medical officer for Scotland Dr Catherine Calderwood originally met with the colleges to discuss the findings of the initial MBRRACE report in March 2015.

She said: “Symptoms may be misinterpreted even by doctors and midwives because problems are rare. This brilliant five-minute clip should be shown to as many healthcare professionals who see pregnant women as possible- it will save lives.”

The video will be launched at the Royal College of Obstetricians and Gynaecologists’ World Congress in Birmingham today.

College president Dr David Richmond said: “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.

“The RCOG welcomes this new innovative resource, which encourages doctors and midwives to ‘red flag’ unwell pregnant women,” she said.

“Raising awareness of symptoms and providing healthcare professionals with advice for better assessment of pregnant and postpartum women who are feeling unwell, is crucial in the fight to prevent the unfortunate deaths that occur during and after pregnancy in the UK,” she added.


Dr Clifford Mann

Clifford Mann

Dr Cliff Mann, president of the Royal College of Emergency Medicine, said: “This video and poster together remind all medical staff of the unique health risks associated with pregnancy and the early post-partum period. It is to be hoped that this will be a further step to reducing preventable maternal deaths.”

The video advises doctors who are assessing pregnant and post-partum women to:

  • Enhance inter-specialty communication and team work as they are crucial in preventing maternal death
  • Never assume that symptoms are just caused by pregnancy
  • Specifically search for cardiac causes of persistent breathlessness or chest pain
  • “Red flag” pregnant and post-partum women who arrive at hospital complaining of ill healthand make sure they are assessed by senior doctors and obstetricians before discharge, as pregnant women may look well but still become sick very quickly
  • Have a low threshold for seeking expert help for pregnant and post-partum women, and not be afraid to ask for help
  • Never stop a woman’s medication such as anti epileptic drugs, without seeking expert advice
  • Provide an urgent phone referral for women who experience worsening epilepsy or a first seizure in pregnancy as it is a high risk condition in pregnancy
  • Not withhold imaging that is regarded as safe, such as CXR, MRI and VQ scans
  • Commence antibiotics or anti virals promptly if there are signs of pneumonia or influenza
  • Re-assess for blood clots at every encounter and prevent with anticoagulant medication
  • Promptly make referrals to specialty departments by phone
  • Familiarise themselves with their patient’s medical history including any pre-existing medical or mental health conditions
  • Pay particular attention to women from complex social backgrounds when assessing for potential mental health problems


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