Maternal Mortality : the need for Obstetric Physicians?
Over the last fifty years there has been a steady decline in Maternal
Mortality within the United Kingdom; primarily due to a reduction in
direct obstetric causes with good practice from multidisciplinary working
practices and lessons learned from the Triennial Reports of the
We commend the editorial by Nelson-Piercy and colleagues drawing
attention to maternal mortality attributed to medical diseases, so called
indirect causes2. This review outlines the fact that the gravid woman
undergoes physiological changes associated with pregnancy and an
understanding of such events is essential for healthcare professionals
managing women with medical disorders in pregnancy. The plausible case is
then made for the subspecialty training of physicians to better understand
and manage these pre-existing or de-novo arising medical disorders in
We would support recognition of the need for additional training for
all clinicians involved in maternity care. This is but one model by which
to improve obstetric care of these women. In many, if not all, tertiary
centres throughout the United Kingdom, obstetricians with RCOG
subspecialty training in Maternal & Fetal Medicine work with expert
physicians in combined obstetric medical clinics. This model provides
obstetricians and physicians working as part of a multidisciplinary team
with midwifery colleagues. In addition, over the last few years, there
has been the introduction of an Advanced Training Skills Module (ATSM) in
Maternal Medicine by the Royal College of Obstetricians (RCOG) &
Gynaecologists and the British Maternal and Fetal Medicine Society. This
provides specialized training to obstetricians, in secondary care, who
wish to build a special interest in this area into their job plans. Thus
there are two models of training for obstetricians to care for pregnant
women with medical disorders of pregnancy are provided by the RCOG
We would urge the UK Department of health to fund these models of
care, so that obstetricians, physicians and other healthcare
professionals, including those outside tertiary centres, can provide
tailored care in obstetric medicine. However, the most important
improvement that can be made is ensuring that all these multidisciplinary
teams work within designated, regional (and sub-regional) Maternity Care
Networks so as to improve communication and care between primary,
secondary and tertiary centre teams.
Clinical collaboration and political will, to establish such
networks, will lead to reduced maternal mortality from all causes, a
situation that all disciplines working with pregnant women will applaud.
Mark D. Kilby, President of the British Maternal Fetal Medicine
Society and Professor of Maternal & Fetal Medicine, University of
Competing interests: none.
1. Centre for Maternal and Child Enquiries (CMACE). Saving Mothers'
Lives: reviewing maternal deaths to make motherhood safer: 2006-08. The
Eighth Report on Confidential Enquiries into Maternal Deaths in the United
Kingdom. BJOG 2011;118 (Suppl. 1):1-203.
2. Nelson-Piercy C, Mackillop L, Williams DJ, Williamson C, Swiet M,
Redman C. Maternal mortality in the UK and the need for obstetric
physicians. BMJ. 2011. 9;343:d4993. doi: 10.1136/bmj.d4993.
Competing interests: Member of Council of the RCOG.