BMJ 2001;323:1324 (



 8 December )


News

Poorest women 20 times more likely to die in childbirth

Susan Mayor, London

Women in the most disadvantaged groups of society are nearly 20 times more
likely to die from causes related to pregnancy and childbirth than women in the
two highest social classes, the latest Confidential Enquiry into Maternal Deaths
for the United Kingdom published this week has shown.

The report is the first in a series to evaluate social and economic factors in
maternal deaths. In addition to showing a greatly increased risk of maternal
death in disadvantaged women, results showed that women from ethnic groups other
than white were on average twice as likely to die. Most of these women spoke
little English. A disproportionate number of women from the traditional
travelling community were also likely to die.

Access to care was an issue for many of the groups of women at increased risk of
maternal death. Twenty per cent of the women who died had booked for maternity
care after 24 weeks of gestation or had missed more than four routine antenatal
visits. The stark reality of women falling outside maternity services was
illustrated by the case of a homeless woman whose body was found wrapped in an
eiderdown in a front garden, after she had died from pregnancy related causes.

A total of 378 deaths were reported to or identified by the inquiry<Picture:
--->similar to the 376 cases reported in the previous report for 1994-6. For the
first time, the number of deaths indirectly related to pregnancy (136) <Picture:
--->owing to pre-existing disease aggravated by pregnancy<Picture: --->exceeded
those directly related (106). Thrombosis and thromboembolism remained the major
direct causes of maternal death, although the rate, 16.5 per million
maternities, had fallen from the all-time high of 21.8 per million maternities
in the last report.

The report showed significant decreases in deaths from pulmonary embolism and
sepsis after caesarean section. Professor James Drife, professor of obstetrics
and gynaecology at the University of Leeds and medical director of the
confidential inquiries, considered that this was likely to have been due to
implementation of Royal College of Obstetricians and Gynaecologists' guidelines
for thromboprophylaxis. "Thromboembolism has always been a heartsink issue in
previous reports. It was encouraging to see that cases had fallen after the
introduction of guidelines."

He noted, however, that women were still dying of potentially treatable
conditions in which the use of simple diagnostic guidelines may help to identify
conditions such as ectopic pregnancy.

Copies of the report, Why Mothers Die 1997-1999, can be obtained from the RCOG
bookshop (tel 020 7772 6275, or www.rcog.org.uk).


 <Picture>(Credit: BSIP, LECA/SPL)
The fall in deaths from thromboembolism is "encouraging"







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