ABSTRACT
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.
Subject(s)
Maternal Health Services/standards , Pregnancy Complications/mortality , Counseling , Female , Health Status , Humans , Maternal Mortality , Patient Care Team , Practice Guidelines as Topic , Preconception Care , Pregnancy , Pregnancy Complications/therapy , Pregnancy Outcome , Prenatal Care/standards , Quality of Health Care , Referral and Consultation , United Kingdom/epidemiologyABSTRACT
A case of pulsation in the abdomen induced by a maladjusted cardiac pacemaker-CRT (cardiac resynchronisation therapy) with an implantable defibrillator is presented. The CRT stimulated the diaphragm causing a repetitive contraction synchronised with the heart beat, giving the picture of an abdominal aortic aneurysm.
