Cemach why mothers die

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You can adjust all of your cookie settings by navigating the tabs on the left-hand side. Strictly necessary Strictly necessary cookies support functional elements of this site such as remembering your cookie preferences, caching and form functions. Enable or Disable Cookies. Following instrumental delivery, syntocinon and IV fluids were administered due to post-partum bleeding. Shortly afterward she suffered a seizure and fatal VF arrest and it became apparent that ml of 0. One woman died following the insertion of a central line.

Invasive monitoring was inserted prior to an urgent caesarean section. She suffered a fatal cardiac arrest and at post mortem was found to have a right-sided haemothorax secondary to trauma caused by attempts to insert a central line. The final death that was directly attributed to anaesthesia occurred in a woman with multiple medical problems and obesity who was admitted a few weeks following delivery for drainage of a renal collection.

She did not want the procedure performed under local anaesthetic. During the general anaesthetic she had a cardiac arrest and died. It was thought her death was due to electrolyte disturbances. Poor anaesthetic management was thought to have contributed to 31 deaths.

There were a number of areas into which these deaths can be grouped:. Established guidelines were not always followed. A slow bolus of 5 units syntocinon rather than 10 units should be administered. A rapid bolus of 10 units syntocinon has been associated with cardiovascular collapse and death. The lack of appreciation and management of sepsis was considered to have contributed to the deaths of 15 of the 21 women who died of sepsis related problems.

Of the 18 women who died as a result of pre-eclampsia or eclampsia, inadequate anaesthetic management was considered to have contributed to the deaths of four. Problems identified related to poor control of hypertension during and after caesarean section. It is part of the maternal resuscitation algorithm and is not performed to save the baby, the survival of which is a welcome bonus. In this Report, there were 52 perimortem CS and 20 babies survived.

These findings indicate that with improved resuscitation techniques, more babies are surviving perimortem CSs, particularly where the women collapsed in an already well-staffed and equipped delivery room or operating theatre. However, they also highlight the very poor outcome for babies delivered in Emergency Departments, especially for women who arrive after having undergone CPR for a considerable length of time.

The babies who survived were born to mothers who were near or at term, and who suffered a cardiac arrest while already undergoing active treatment in the Emergency Department.

Trainees must know their limitations and should not hesitate to call for help, which should be readily available. The management of patients should be multidisciplinary and teamwork should be encouraged. In pregnancy, the increase in physiological reserve may mask the signs of critical illness, resulting in a delay in diagnosis and appropriate management. The obstetric modifications to the usual early warning chart parameters ventilatory frequency, temperature, heart rate, SAP, mental response, urine output, and oxygen saturation add specific obstetric indicators such as proteinuria, diastolic AP, and amniotic fluid or lochia consistency.

Figure 3 shows an example used by Stirling Royal Infirmary, which was published in the current Report and can be adopted by Trusts.

Such a chart should be introduced in all areas dealing with pregnant patients. It should be noted that while a carefully completed MEOWS chart can indicate deterioration requiring action, a robust mechanism to ensure that the appropriate and prompt action actually occurs is also required to alter the outcome. Reproduced with kind permission from Dr Fiona McIlveney. Obesity in pregnancy carries major risks such as pre-eclampsia, thromboembolism, post-partum haemorrhage, gestational diabetes, cardiac disease, recurrent miscarriage, wound infection, congenital abnormality, prematurity, and stillbirth.

This recommendation has serious implications for staffing of labour wards and is therefore controversial. Guidelines for the management of morbidly obese patients should be readily available in all obstetric units and should include details of the availability of equipment such as wider maternity beds, operating tables with width extensions, larger thromboembolic deterrent stockings, long regional block needles, and large AP cuffs.

Manpower and electrically operated equipment for positioning should be available and staff should be encouraged to attend a manual handling course with special attention to manual handling of the obese patient. This is the third most common cause of maternal death, with a total of 45 deaths 41 direct and four late, MMR 2. Again, this is an increase compared with the 32 cases in —7 MMR 1. Twenty-two deaths including one in early pregnancy and three late deaths occurred from genital tract sepsis in the current triennium MMR 1.

Substandard care was identified in 15 cases. Maternal tachycardia, constant severe abdominal pain and tenderness are important early features of genital tract sepsis that should prompt urgent medical review. Pyrexia and raised white cell count are not always present. Anaesthetists are familiar with the diagnosis and management of septic shock and should be proactive in leading the labour ward team where necessary. If sepsis is suspected, regular frequent observations should be made and the use of the MEOWS chart is crucial see recommendation 9 above.

Cardiac disease is now the leading cause of maternal death, with a total of 82 deaths MMR 3. Interestingly, the top 10 recommendations do not include any comment on cardiac disease, other than migrant women should have a full medical history and examination at booking—perhaps, this advice should be extended to all women at booking.

Cardiac deaths include 16 myocardial infarcts mostly associated with obesity, older age at childbirth, smoking, and poor diet , 12 peripartum cardiomyopathies soon to be reclassified as direct maternal deaths , and nine thoracic aortic dissections. These latter two categories mainly include ischaemic heart disease, cardiomyopathy, aneurysm, and myocarditis.

Most repaired lesions, uncomplicated shunts, and mild valve disease represent a low risk 0. Most cardiac patients are now managed by vaginal delivery, with CS usually reserved for appropriate obstetric indications.

Labour requires effective pain relief with careful, slowly established low-dose epidural block and monitoring with ECG, pulse oximetry, and direct AP. Systemic vascular resistance should be maintained and vasodilators such as oxytocin should be avoided—diluted ergometrine may be preferable. Phenylephrine is the vasopressor of choice. Particular care should be taken to avoid bleeding, pulmonary oedema, arrhythmias, thromboembolism, air embolism with shunts, and bacterial endocarditis.

Anaesthesia for CS may be regional or general, and the care with which each technique is administered is more important than the choice of technique in most cases. A clear understanding of the precise nature of the lesion, the presence or absence of pulmonary hypertension, and the degree of anticoagulation will guide the decision. Google Scholar. Google Preview. Oxford University Press is a department of the University of Oxford.

It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide. Sign In or Create an Account. Sign In. Advanced Search. Search Menu. Article Navigation. Close mobile search navigation Article Navigation. Volume This article was originally published in.

Article Contents Anaesthesia as a continuing cause of maternal death. The top 10 recommendations: lessons for anaesthetists.

Lessons not included in the top 10 recommendations. Conflict of interest. StR in Anaesthesia.