Maternal mortality – is it still relevant in this day and age?

Posted: 01/10/2015

It seems alarmist to be talking about pregnant women dying in the UK in this century, but it does still happen. Medical treatment for pregnant women can be complex with there being a delicate balancing act to achieve between potential complications for the pregnancy associated with some forms of investigation, radiology and medication, versus the potential harm of not treating the condition in question. We have heard it said, in jest of course, that general physicians panic when faced with a pregnant patient and that obstetricians have long forgotten the medicine they learnt at medical school! Are pregnant women effectively falling between two stalls? 

Older mothers are at greater risk during pregnancy. The NHS doesn’t generally fund IVF for mothers over 40 for this reason. However, it should really be the ‘biological age’ rather than ‘chronological age’ that determines clinical approach. One misnomer is that radiology is unsafe in pregnancy and should be avoided. It should certainly be limited, where possible, but statistically it is safe in pregnancy being roughly equivalent to the exposure of one transatlantic flight. 

Maternal mortality is thankfully on the decline but still an important issue. Women are delaying getting pregnant in favour of other life choices so expectant mothers are getting older. Menopause and sub/infertility are no longer the barriers to pregnancy that they used to be, given advances in fertility treatment. Women in poorer health, for all sorts of reasons, are still able to conceive. 

Maternal mortality may be termed direct (pregnancy caused), indirect (related to a pre-existing condition aggravated by the pregnancy), coincidental (a fatal accident whilst pregnant for example) or late (often psychiatric). Direct maternal mortality can be caused by pre-eclampsia or a serious obstruction during labour itself. These risks are relatively well known. Perhaps lower on the radar for most people are the indirect risks – pregnancy places great strain on the heart for example. Women with heart conditions, diabetes or kidney disease can be at significantly greater risk during pregnancy and their own medical treatment needs to be managed very carefully. 

Obstetric physicians care for women with medical problems in pregnancy. There are currently only five consultant obstetric physicians in the UK and we wonder why this is when they play such an important role. In the ideal world there would be one available to every pregnant woman who needed specialist advice during her pregnancy as ultimately, in layman’s terms, the unborn baby is part of mum so it is essential to keep mum safe and well for both of them.

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