Adapted from BMJ 19 Oct 2024
The current maternal death rate in the UK is the highest it has been in the last 20 years. These deaths include all deaths in women who are pregnant or within 6 weeks of delivery. The most frequent causes are blood clots 16%, Covid-19 14%, and cardiac disease 13%. 275 deaths occurred.
Deaths between 6 weeks post partum and one year also occurred in 329 women. Most of these were due to mental health problems 34%. Substance misuse and suicide were the leading causes.
Black women had three times the death rate of white women. Asian women had double the risk.
Women over the age of 35 had triple the risk of those aged 20-24.
Women in the most deprived areas had triple the risk compared to women in the least deprived areas.
9% of women who died had multiple disadvantages such as mental ill health, substance abuse or domestic abuse.
Overall, the death rate rose from 11.66 per 100,000 pregnancies in 2017-19 (pre-covid) and 13.56 per 100,000 in 2020-22 (during Covid). Some of the deaths were related to delays in pre-hospital care which were directly related to the pandemic. Others were due to the fact that women are getting pregnant later in life and obesity continues to rise.
One in four women who died of venous thrombo-embolism died in the first trimester of pregnancy, sometimes before any risk evaluation by hospital teams could be done. The Royal College of Obstetricians and Gynaecologists want the VTE risk assessment tool to be restructured so it is clear and easy to use. They want GPs to obtain timely specialist advice, with clear pathways of referral.
My comment: In most of my work as a GP, the first port of call for a woman who thought she was pregnant or who had confirmed a pregnancy was the GP. In the last ten years of my work, since around 2010, however, the entire pregnancy referral process was put in the hands of midwives. Once in the hands of the midwife, I would imagine that it would be easy for screening tools to be employed, and appropriate consultant referrals made. It would seem to me that in order to identify women who are at risk of VTEs in pregnancy, a screening tool that could be done online by women themselves or by other health care professionals will be needed. This could be done when a woman presents for contraception advice or opportunistically when she seeks routine health care. This could identify to individual women whether they need to be fast tracked to an obstetrician in the event of a pregnancy occurring, instead of waiting on the usual midwife led pathway.
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