Call for action over ‘worrying’ number of pregnancy deaths

Problems of obesity and growing numbers of older mothers have led to a rise in the number of “high risk” pregnancies where women can suffer a complex mix of health problems.

And the experts warn that many women are dying unnecessarily from conditions which are preventable or treatable medical conditions.

Writing in the British Medical Journal (BMJ), Catherine Nelson-Piercy, professor of obstetric medicine at King’s College London, and colleagues called for an increase in the number of obstetric physicians and better training for GPs.

While the overall number of deaths has decreased since the 1950s, there has been a rise in the number dying from conditions not directly caused by pregnancy – which represents a “worrying trend”. The leading cause of maternal death is heart disease while the second is neurological disease.

Most of these deaths are associated with substandard care and “in one third of cases this is classified as major substandard care, where different care might have prevented death of the mother,” they added. “These failings require urgent attention.”

In March, a report from the Centre for Maternal and Child Enquiries (CMACE) revealed that 261 women in the UK died from conditions directly or indirectly related to pregnancy for the three years from 2006 to 2008.

Some 107 mothers died of conditions that could only have arisen if they had been pregnant (direct deaths), while 154 died of indirect causes, including infections and underlying health problems.

The researchers said some women die every year from treatable conditions such as epilepsy, diabetes and asthma but there can sometimes be a failure to diagnose these women properly, investigate their symptoms and treat them currently.

In particular they highlight the problems posed as some career-minded women put off having children until later in life to focus on their job and levels of obesity rise.

“Increasing numbers of women with often complex medical conditions are now becoming pregnant or seeking fertility treatment. Women are delaying childbearing until later in life, and the menopause is no longer a barrier to pregnancy.

“Older women are more likely to be obese, have hypertension, or be predisposed to gestational diabetes and thromboembolism.”

The team proposes increasing the number of obstetric physicians and insisting GPs and other doctors are trained in obstetrics as they say already happens in the United States, Canada, Australia and New Zealand.

This could help them to look for signs of possible underlying problems, such as breathlessness, headache and abdominal pain.

A spokeswoman for the Department of Health said: “There has been a significant reduction in the number of women dying during pregnancy in the UK, but every death is one too many.

“We are committed to ensuring that every woman gets safe and quality maternity services.

“Over the last decade we have seen a 46.6 per cent increase in the number of doctors in obstetrics and gynaecology and a 64.4 per cent increase in consultants.”

The obstetrician training curriculum is developed by the Royal College of Obstetricians and Gynaecologists.