by Dr Samantha Gan
A report from the latest enquiry into maternal deaths has highlighted a significant rise in mortality rates due to pre-existing or new onset medical conditions. In an age where, according to the latest NHS statistics, almost a quarter of adults in Britain are classified as obese, it is perhaps unsurprising that the leading cause of indirect maternal death was found to be heart disease.
Other causes of indirect maternal death include epilepsy, diabetes, and asthma. In addition, the trend in women delaying childbirth until later in life has added to the number of high risk births, as older women have a greater likelihood of suffering from obesity and hypertension, and being predisposed to birth complications such as gestational diabetes and thromboembolism. These conditions are eminently treatable, however, and patient deaths are preventable.
An editorial in the British Medical Journal writes, “…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. These failings require urgent attention.”
However, obstetricians and midwives cannot hope to stem the tide of maternal deaths alone – physicians and GP’s must support them, the editorial urges. The maternal deaths enquiry report emphasises a need for better training for general practitioners, so that they are more knowledgeable about the interactions between their patient’s existing conditions and pregnancy. The report has also recommended pre-pregnancy counselling for all women with pre-existing medical conditions, so that they have a better understanding of their risks, and how to better manage their pregnancy, and an increase in the number of obstetric physicians, obstetric specialists who can be available to consult with obstetricians, physicians, and general practitioners as needed.
Clearly, a more integrated care system is needed where general practitioners, specialists, obstetricians, pharmacists, and the patients themselves can collaborate on patient care, and the use of collaborative technologies could go a long way in helping patients to manage their chronic diseases and improve their pregnancy outcomes.