Intended for healthcare professionals


Maternal mortality in the UK and the need for obstetric physicians

BMJ 2011; 343 doi: (Published 09 August 2011) Cite this as: BMJ 2011;343:d4993
  1. Catherine Nelson-Piercy, professor of obstetric medicine and consultant obstetric physician1,
  2. Lucy Mackillop, consultant obstetric physician2,
  3. David J Williams, consultant obstetric physician3,
  4. Catherine Williamson, professor of obstetric medicine4,
  5. Michael de Swiet, emeritus professor of obstetric medicine4,
  6. Christopher Redman, professor of obstetric medicine2
  1. 1Guy’s and St Thomas’ Foundation Trust, St Thomas’ Hospital, London SE1 7EH, UK
  2. 2John Radcliffe Hospital, Oxford, UK
  3. 3University College Hospital, London, UK
  4. 4Queen Charlotte’s and Chelsea Hospital, Imperial College Healthcare Trust, London, UK
  1. catherine.nelson-piercy{at}

Most deaths are now caused by preventable or treatable medical conditions

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 …

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