Factors associated with progression from near-miss maternal morbidity to fatality

Summary

The UK led the world in the development of confidential enquiries into maternal deaths. Since the introduction of these confidential enquiries, maternal mortality has decreased 10-fold. Data from UKOSS studies have been used to provide contextual information about underlying maternal morbidity to complement the detailed examination of mortality, but formal comparison between the information concerning women who suffered near-miss maternal morbidity and those who died from the same conditions has not been undertaken. The aim of this analysis was to compare women with severe maternal morbidity, identified through UKOSS, with women who died from the same conditions, identified from the UK Confidential Enquiries into Maternal Deaths between 2003 and 2008. Women were included if they had eclampsia, antenatal pulmonary embolism, amniotic fluid embolism, acute fatty liver of pregnancy or antenatal stroke.

Key findings

• The women who died were older (age 35+ years aOR 2.36, 95%CI 1.22-4.56), more likely to be of black ethnicity (aOR 2.38, 95%CI1.15-4.92), and unemployed, routine or manual occupation (aOR 2.19, 95%CI1.03-4.68). We also observed an association with obesity (BMI ≥ 30kg/m²aOR 2.73, 95%CI 1.15-6.46).
• Women from vulnerable populations in the UK thus remain at increased risk of maternal death in the presence of severe maternal morbidities.
• It is not clear whether the increased risk of death was related to difficulties in access to maternal care through physical (location) or cultural factors.
• There is a place for more in depth studies to determine exactly why the presence of these factors makes women more likely to die, but it is evident that there is a place for public health action to reverse the rising trends in maternal age at childbirth and clinical action to mitigate its effects, and to reduce the burden of obesity in pregnancy.
• In addition, development and evaluation of services to mitigate the risk of dying associated with being of black Caribbean or African ethnicity and being unemployed or from routine or manual socioeconomic groups is essential.

Publications

Journal Articles

• Kayem G, Kurinczuk J, Lewis G, Golightly S, Brocklehurst P, Knight M. Risk Factors for Progression from Severe Maternal Morbidity to Death: A National Cohort Study. PLoS One. 2011;6(12):e29077.
• Shah A, Mohamed-Ahmed O, McClymont C, Knight M. Conditions triggering local incident reviews in UK hospital maternity units: A national survey. JRSM Open. 2014;5(7):2054270414528898.
• Nair M, Kurinczuk JJ, Brocklehurst P, Sellers S, Lewis G, Knight M. Factors associated with maternal death from direct pregnancy complications: a UK national case?control study. BJOG. 2015;122(5):653-62.