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Maternal mortality in the UK and the need for obstetric physicians

BMJ 2011; 343 doi: https://doi.org/10.1136/bmj.d4993 (Published 09 August 2011) Cite this as: BMJ 2011;343:d4993

Rapid Response:

Maternal mortality in the UK and the need for obstetric physicians

Nelson-Piercy et al (1) pursue an interesting line on the most recent
confidential enquiry into maternal deaths in the UK (2). While they
correctly note an overall rise in indirect causes of maternal deaths since
the 1980's, and the encouraging fall in direct causes over the same time
period, they do not comment on the decline in indirect deaths in the past
decade despite rising levels of obesity and of maternal age. The overall
maternal mortality rate in the UK in 2006-8 was the lowest since the 1991-93 triennial report. Although the recent report does recommend the
referral of those with potentially serious medical problems to specialist
centres, the strongest message is for the early recognition of potential
and developing illness through improved "back to basics" clinical skills
and then appropriate and prompt referral and involvement of relevant
specialist expertise. This expertise may be a general practitioner, an
obstetrician or a clinician of another speciality.

Many of the deaths recorded in the report might have been prevented by the
early application of basic principles of observation, recognition,
management and referral. More fully trained obstetric physicians might
help a very small number of women but far more are likely to benefit from
the recognition that a wide spectrum of practitioners, both doctors and
others, in hospital and community settings require (re)training in these
very achievable and probably more effective 'basics'.

(1) BMJ 2011:343:d4993

(2) 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

Competing interests: No competing interests

25 August 2011
Christopher E Lennox
Consultant obstetrician and Clinical advisor
Healthcare Improvement Scotland, NHS Scotland