New measures promote red flag warnings to help prevent maternal deaths
June 29 2016
New resources to help doctors assess unwell pregnant or post-partum women, and to increase awareness of red flag issues, have been published. A video and poster address concerns that more needs to be done to prevent maternal deaths from causes not directly linked to pregnancy and childbirth.
The animated video, ‘It's better to ask: working together to prevent maternal mortality’, and poster, ‘Three Ps in a pod’, highlight “the main causes of maternal death and provides doctors and midwives with advice for assessing pregnant and post-partum women who are feeling unwell.”
The resources are part of a collaborative project set up by the Royal College of Physicians and Surgeons of Glasgow and the Royal College of Obstetricians and Gynaecologists.
One in 10,000 pregnancies in the UK and Ireland results in the death of the mother, said the RCOG. A 2014 study found that “while 32% of these deaths were a direct consequence of complications during pregnancy, such as pre-eclampsia or bleeding, 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 (23%),
- influenza and pneumonia (14%),
- deep vein thrombosis (11%),
- neurological conditions such as stroke or epilepsy (11%)
- mental health problems resulting in suicide (9%).
“Three quarters of women who died had a previous history of medical or mental health problems,” said the RCOG. “From 2003-2005, 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 2009-2011. However, the number of women who died following medical or mental health problems has not seen any significant decrease (7.76 per 100,000 in 2000-2002, compared to 7.15 per 100,000 in 2009-2011).”
Advice for doctors who are assessing pregnancy and post-partum women includes the following recommendations:
- Enhance inter-specialty communication and team work as they are crucial to 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 health and 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 women’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.
- Do 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.
- Doctors should 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.
RCOG President Dr David Richmond said: “While the number of women dying from complications directly associated with pregnancy has fallen, 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, such as mental health problems, epilepsy, heart disease or cancer.
“RCOG welcomes this new innovative resource, which encourages doctors and midwives to ‘red flag’ unwell pregnant women. 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.”