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More action needed for pregnant women with pre-existing conditions

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Childbirth-related deaths in the UK have fallen in recent years but more needs to be done to ensure maternity services are designed for women with pre-existing medical conditions, a new report has found.

The report, called Saving Lives, Improving Mothers’ Care, shows that deaths linked to maternity decreased over four years – from 11 occurring in every 100,000 pregnant women in 2006–08, to 10 per 100,000 in 2010-12.

Led by the University of Oxford’s National Perinatal Epidemiology Unit, the research found that the overall drop in deaths had been driven by a decrease in the rate of deaths directly caused by pregnancy complications, such as eclampsia, blood loss or blood clots.

“There is a need for coordinated and concerted action at all levels to improve the care of women with medical complications”

Marian Knight

This is “evidence of commitment to and success in improving the care of women with obstetric complications in pregnancy throughout the health service”, said the foreword to the report, which was signed by all the UK chief medical and nursing officers.

However, they highlighted that the majority of women who died during pregnancy, or within the six weeks after, did so from an exacerbation of their pre-existing medical and psychiatric conditions and action needed to be taken to address this.

Two-thirds of mothers died from these indirect causes and the rate of these deaths has not reduced in 10 years, said the report.

University of Oxford

Marian Knight

To save the lives of women with these pre-existing conditions in the future, healthcare professionals should provide better pre-pregnancy advice, as well as joint specialist and maternity care through pregnancy and birth, said the report.

In particular, guidelines for pregnant and postpartum women with epilepsy are “urgently required” to standardise and improve their care, the report added.

It also recommended that efforts continue to ensure pregnant women are immunised against flu and that improvements are made around the diagnosis and care of mothers with sepsis, both of which can lead to maternal deaths.


“There is a need, above all, for coordinated and concerted action at all levels to improve the care of women with medical complications before, during and after pregnancy,” said Marian Knight, a professor of maternal and child population health, who led the enquiry.

Jennifer Kurinczuk, who also worked on the programme which led the research, added: “There is good news in this report – deaths are decreasing – but there are still things we can do based on existing evidence-based guidelines.

“We owe that to the families left behind,” she said. “We need to be able to say to the relatives of women who died that we are learning every lesson we can.”

“The NHS needs to do more to prioritise these women’s care in its already overstretched maternity services”

Louise Silverton

The Royal College of Midwives welcomed the report and the overall reduction in maternal deaths. But it said it remained concerned about the high rate of deaths among pregnant women with pre-existing conditions.

RCM director for midwifery Louise Silverton said: “The NHS needs to do more to prioritise these women’s care in its already overstretched maternity services.

“We need more midwives and maternity support workers to deal with the increasing complexity of pregnancy and better teamwork with doctors to provide seamless maternity care,” she said.

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