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Written on 11th November 2022 by Susan Brown

The latest Saving Lives, Improving Mothers’ Care report from maternity care investigator, MBRRACE-UK, has warned that the rate of deaths amongst pregnant, birthing and postnatal women is increasing.  Their latest annual report looks at the care received by 536 women who died from 2018 to 2020 during pregnancy, or up to one year after pregnancy ended. It warns that despite the government’s ambition to reduce maternal mortality (pregnancy and birth-related death of women)  in England by 50% between 2010 -2025,  the maternal mortality rate has risen by 8% since 2010-12. The report calls for urgent action to deal with increasing numbers of women with multiple physical conditions such as diabetes, high blood pressure and obesity, and for greater understanding and engagement with those affected by social deprivation or mental health concerns.   

Facts, figures and findings from MBRRACE-UK’s report into maternal deaths from 2018-2022

A total of 536 pregnant, birthing or postnatal women died in the UK in the three years from 2018 and 2020, leaving behind them 366 motherless children. Of these women:

  • 229 died during or up to six weeks after the end of pregnancy. The maternal mortality rate (per 100,000 giving birth) was 24% higher than in 2017 to 2019.  
  • A further 289 women died between six weeks and a year after the end of pregnancy.
  • 64 women (28%) were still pregnant at the time of their death, mostly at less than 20 weeks’ gestation.
  • 85% of the women who died gave birth in hospital (excluding A&E).
  • 12% gave birth in an emergency department (A&E / ED) or an ambulance;
  • 4% gave birth at home.  
  • 91 (64%) had a caesarean birth. 11% of these were perimortem (around the time of the mother’s death) during attempted resuscitation.  

Out of 144 cases where there was enough information to analyse the standard of care that was given to the mother:

  • Only 44% received correct antenatal care as recommended by the NICE antenatal care guidelines;
  • 22% received good care;
  • 38% could have had a better outcome if they had received better care;
  • 40% should have received better care but improvements in care would probably not have affected their outcome.

One of the conditions in which women’s outcomes were commonly affected by poor care was a diabetes-related obstetric emergency called diabetic ketoacidosis (DKA). Diabetes and other related (often multiple) health conditions increase the risk of death and long term injury for the pregnant mother and unborn baby. MBRRACE-UK found that delayed recognition and treatment of the DKA and failure to escalate the woman to critical care contributed to some of their babies being stillborn.

This report highlighted the increased risk to women with multiple health problems in pregnancy, made worse by care from healthcare teams who are inexperienced in pregnancy medicine.

  • Nearly two-thirds (60%) of the women who died in 2018-20 were known to have pre-existing medical problems.
  • 37% were known to have pre-existing mental health problems.
  • More than a quarter (27%) were classed as obese and a further 24% were overweight.

Common causes of death were similar to previous reports:

  • Thrombosis (blood clots) and thromboembolism (VTE) is still the leading direct cause of maternal deaths within six weeks of the end of pregnancy. The report highlighted that the ongoing consistent maternal death rate from VTE suggests that better care could have prevented death in some cases. 
  • Suicide, pregnancy-related sepsis (increasing) and obstetric haemorrhage (unchanged) were the next most common direct causes of maternal death.
  • 9 women died from covid before treatments or vaccinations were available.

8 women died from pre-eclampsia. MBRRACE-UK predicts that health trends suggest that pre-eclampsia and conditions related to high blood pressure (hypertension) are expected to affect significant numbers of women for the foreseeable future and warns maternity and medical teams not to become complacent about their care. Amongst its recommendations, the report advises women to be aware that they have a higher risk of pre-eclampsia:

  • where their pregnancy is their first, or is a multiple pregnancy or follows a 10-year gap since their last pregnancy;
  • if they are aged 40 or over;
  • if their BMI is 35 or more;
  • if they have a family history of pre-eclampsia.

Just over half (52%) of maternal deaths had indirect causes. Cardiac or heart disease is still the most common indirect cause of maternal death. MBRRACE-UK found that in almost one third of cases where the mother’s death was related to heart disease, better care could have prevented the woman’s death.

Heart disease in pregnancy is a growing concern as women enter pregnancy with increasing numbers of risk factors. The report warns that recognition of heart disease occurring for the first time in or after pregnancy is vital. Heart disease should be considered as a possible diagnosis for women who have pain, wheeze and breathlessness. The report reminds maternity staff to be aware and advise women of the common risk factors and ‘red flags’ for heart disease, including:

  • older age;
  • smoking;
  • obesity;
  • diabetes;
  • high blood pressure (hypertension) or related disorders;
  • family history of premature heart disease;
  • hypercholesterolaemia (high cholesterol levels).

The report reminds pregnant women that heart disease can occur for the first time in pregnancy, and that they should let their healthcare team know if they have a family history of heart disease or sudden death. They should also seek urgent medical advice if they experience any of the following red flag symptoms:

  • severe chest pain spreading to their jaw, arm or back;
  • their heart persistently racing;
  • severely breathlessness when resting, especially if it happens when they are lying flat;
  • fainting while exercising.

Other common indirect causes of maternal death included:

  • neurological causes – the second most common indirect cause of maternal death;
  • venous thromboembolism;
  • pulmonary oedema.

Eight women died during pregnancy or within six weeks after the end of pregnancy from high blood pressure related (hypertensive) disorders of pregnancy, including following brain haemorrhage related to HELLP syndrome, and eclamptic seizures. In three quarters of these cases, the woman’s death might have been avoided if they had received better care.

MBRRACE-UK’s advice to any woman who is pregnant or planning pregnancy is to remember that pregnancy may affect their health throughout and after pregnancy. Those with pre-existing health conditions should try to get specialist advice before becoming pregnant and should not stop their medication without expert advice. It is also vital that they stay in touch with their usual care teams and keep their GP and midwife informed.

MBRRACE-UK’s findings on the impact of social factors and ethnicity on the risk of maternal death repeated the shocking findings of other recent reports:

  • 1 in 9 (11%) of women who died had severe/multiple disadvantage and struggled to engage with health and social services;
  • Black women were 3.7 times more likely to die than white women;
  • Asian women were 1.8 times more likely to die than white women;
  • More women from deprived areas are dying and this continues to increase.

Boyes Turner’s birth and obstetric negligence team recognise the valuable work carried out by MBRRACE-UK and their efforts to bring about improvements in maternity care. We are always saddened to read about these deaths, each of which represents a devastating loss to a young family. We remain committed to helping families who have lost mothers as a result of negligent care.

If your family has been affected by the death of a mother or injury to a mother or child as a result of negligent care, you talk to one of our experienced solicitors, free and confidentially, find out more about how we can help you make a claim or respond to HSIB, MNSI or NHS Resolution,  by contacting us here.