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Monday, November 23, 1998 Published at 18:18 GMT


The causes of maternal death

For most women in the UK, childbirth is a safe process

Health workers are being given new standards for cutting the number of women who die in childbirth.

A government-commissioned report on maternal deaths between 1994 and 1996 recommends new standards for improving the care of women before, during and after their pregnancy.

The Report of the Confidential Enquiries into Maternal Deaths says guidelines should be provided for many areas affecting maternal health, such as the use of antibiotics for women who have Caesarian section births and the management of women who refuse to use blood products.

It highlights some of the danger signs for some conditions which it says health workers should be aware of.

For example, gastrointestinal problems, including diarrhoea, may be a symptom of ectopic pregnancy.

It also calls for higher awareness of problems such as post-natal and ante-natal depression.

It proposes that women with a history of psychiatric disorder, substance abuse or self harm should be carefully monitored after birth.

Some 268 women's deaths were directly or indirectly linked to pregnancy between 1994 and 1996.

Some of the trends spotted by the report include a continued stress on the risk to older women having children and a suggestion that black women are more likely to be at risk because of poor attendance at ante-natal clinics, lack of understanding of their needs and, for women whose first language is not English, communication problems.

Main causes of death

The main cause of death which was directly related to pregnancy was thromboembolism - clotting of the blood.

Forty-eight women died from this, compared with 20 from hypertension, 17 from amniotic fluid embolism, 12 from ectopic pregnancies and 14 from sepsis infection.

Only one woman died in the period from a reaction to anaesthetic and there was a decrease in deaths from haemorrhage and deaths in the early stages of pregnancy.

Deaths that were indirectly related to pregnancy include 39 women who died of heart disease, 19 of epilepsy and nine from psychiatric problems, including suicide.

Six women died as a result of domestic violence.

In some cases, substandard care was a factor in deaths, including failure to diagnose ectopic pregnancy and other life-threatening conditions.

Around the world

In Britain, 12.2 per 100,000 pregnancies end in the death of the mother.

This compares to an average of 27 deaths per 100,000 pregnancies in the developed world as a whole and 480 deaths per 100,000 in developed countries.

According to the World Health Organisation, 1,600 women a day die from complications in pregnancy and childbirth, making an annual toll of at least 585,000 deaths.

In addition, more than 50 million women suffer complications which lead to long-term health problems, including infertility and permanent incontinence.

Asia and sub-Saharan Africa are the worst affected. Almost 90% of deaths occur there, compared to less than 1% in the developed world.

In some developing countries, between a quarter and a third of all deaths of young women are due to problems related to pregnancy.

The WHO says it is the one of the biggest differences between developing and developed countries.

Women in developing countries are18 times more likely to die than those in richer countries. The infant mortality rate is only seven times higher.

The WHO says inadequate healthcare and nutrition are mainly to blame.

It believes that an extra $3 per person could prevent many deaths and health complications.

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World Health Organisation on maternal deaths

Report of the Confidential Enquiry into Maternal Deaths

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