Saving Mothers' Lives: Reviewing maternal deaths to make motherhood safer: 2006-2008. The Eighth Report of the Confidential Enquiries into Maternal Deaths in the United Kingdom.

In the triennium 2006-2008, 261 women in the UK died directly or indirectly related to pregnancy. The overall maternal mortality rate was 11.39 per 100,000 maternities. Direct deaths decreased from 6.24 per 100,000 maternities in 2003-2005 to 4.67 per 100,000 maternities in 2006­2008 (p = 0.02). This decline is predominantly due to the reduction in deaths from thromboembolism and, to a lesser extent, haemorrhage. For the first time there has been a reduction in the inequalities gap, with a significant decrease in maternal mortality rates among those living in the most deprived areas and those in the lowest socio-economic group. Despite a decline in the overall UK maternal mortality rate, there has been an increase in deaths related to genital tract sepsis, particularly from community acquired Group A streptococcal disease. The mortality rate related to sepsis increased from 0.85 deaths per 100,000 maternities in 2003-2005 to 1.13 deaths in 2006-2008, and sepsis is now the most common cause of Direct maternal death. Cardiac disease is the most common cause of Indirect death; the Indirect maternal mortality rate has not changed significantly since 2003-2005. This Confidential Enquiry identified substandard care in 70% of Direct deaths and 55% of Indirect deaths. Many of the identified avoidable factors remain the same as those identified in previous Enquiries. Recommendations for improving care have been developed and are highlighted in this report. Implementing the Top ten recommendations should be prioritised in order to ensure the overall UK maternal mortality rate continues to decline.

Reassurance through surveillance in the face of clinical uncertainty: the experience of women at risk of familial breast cancer.

OBJECTIVE: To identify the main issues raised by clinicians when they are counselling women at risk of breast cancer and explore the response of a group of women 1 year after counselling. DESIGN: A qualitative study which involved the thematic analysis of a series of transcripts from clinical consultations, semi-structured interviews and focus groups. PARTICIPANTS: First, a series of clinical consultations (n=153), involving seven clinicians, were randomly selected during a Medical Research Council funded study of genetic assessment (TRACE). Second, a group of women (n=43), involved in the TRACE study, were interviewed, or joined a focus group, 1 year after their genetic assessment. CONCLUSIONS: There was evidence that, although the clinical consultations were embedded with multiple messages of uncertainty, the women's accounts did not reflect this. The women talked about the reassurance they had found because they had met with an expert and become members of the surveillance society. The authors highlight the tension that exists because of the difference between lay expectations about on-going surveillance and the realities of collective service provision.