Intended for healthcare professionals


Reducing maternal deaths from hypertensive disorders: learning from confidential inquiries

BMJ 2019; 364 doi: (Published 05 February 2019) Cite this as: BMJ 2019;364:l230
  1. Frances Conti-Ramsden, academic clinical fellow1,
  2. Marian Knight, professor of maternal and child population health2,
  3. Marcus Green, chief executive officer3,
  4. Andrew H Shennan, professor of obstetrics1,
  5. Lucy C Chappell, NIHR research professor in obstetrics1
  1. 1Department of Women and Children’s Health, School of Life Course Sciences, King’s College London, London, UK
  2. 2National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
  3. 3Action on Pre-eclampsia, The Stables, Evesham, Worcestershire, UK
  1. Correspondence to: L Chappell lucy.chappell{at}

Lucy Chappell and colleagues examine the dramatic reduction in maternal deaths from hypertensive disorders of pregnancy in the UK and discuss how systematic confidential inquiries may have contributed

Key messages

  • Confidential inquiries into maternal deaths in the UK were established in 1952 and have aimed to report on every pregnancy related death since then

  • Maternal deaths from hypertensive disorders of pregnancy have reduced dramatically in the UK over the past 60 years

  • Incremental improvement in clinical management and organisation of care through recommendations made in the confidential inquiry reports and publication of national guidelines are likely to have driven much of this decline in recent decades

  • To tackle global maternal mortality related to hypertensive disorders, setting up a confidential inquiry is an important first step for many countries

  • Almost complete eradication of maternal mortality related to hypertensive disorders of pregnancy seems possible

Maternal deaths in the United Kingdom have been the subject of confidential inquiries since 1952. In this time, deaths from hypertensive disorders of pregnancy have substantially reduced in both absolute and relative terms, from 200 women in a three year period in England and Wales (1952-54), to three women across the whole of the UK in the most recent report (2013-15).1 Deaths from hypertensive disorders are also falling globally, but not as dramatically as in the UK.2 Pre-eclampsia and eclampsia are still estimated to cause approximately 30 000 maternal deaths annually worldwide, mostly in low and middle income countries.34 As with any death, maternal deaths have a huge impact on families, particularly as they are usually unexpected in young adults and involve a child (box 1).

Box 1

Experiencing pre-eclampsia

“Losing anyone is hard at any time but losing your partner when you are on the cusp of becoming a family is the most devastating thing that can happen to …

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