Maternal mortality in the UK and the need for obstetric physicians

Since the first report of the Confidential Enquiry into Maternal Deaths in 1952, the maternal death rate in the United Kingdom has decreased dramatically.1 This has been due to an impressive fall in deaths with direct obstetric causes, including obstetric haemorrhage, ectopic pregnancy, and venous thromboembolism. This has partly been achieved through better understanding of obstetric complications, advances in medical treatments, and the use of evidence based guidelines that implement recommendations made in previous reports.2 However, almost 60 years since the first Confidential Enquiry into Maternal Deaths report, the most recent report, published in March 2011, highlights a worrying trend in the causes of maternal mortality in the UK.1

The report states that most maternal deaths in the UK now occur in women with pre-existing or new onset medical and psychiatric conditions (“indirect causes”). The leading cause of maternal death remains cardiac disease; the second is neurological disease. Most worryingly, the number of maternal deaths due to indirect causes has significantly increased over the past 20 years (table⇓). Furthermore, 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 …