Mortality data delivers surprising results

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... maternal death is rare in the developed world.

While 600,000 such deaths occur worldwide every year, predominantly in developing countries, cases in Ireland number just a handful – and perhaps it is their rarity that makes them so shocking.

The death last week of a woman in her late 30s, shortly after giving birth ... brings the topic to the fore.

So too did the death of 34-year-old Tania McCabe, who in March 2007 died after giving birth to twins ... One of Ms McCabe’s twin boys died too.

The HSE admitted negligence in that case and damages were recently paid to her family, but ensuring that broader lessons are learned from these and other maternal deaths is the job of a Cork-based body.

The Centre for Maternal and Child Enquiries (CMACE) was established in April 2009 ... CMACE Ireland works closely with its long established UK counterpart and, from January 2009, all Irish maternal mortality data is included in the CMACE UK triennial report.

... “Merging the data ... enables us to accumulate enough cases of one condition from which to draw conclusions and recommendations,” ...

... “One of the greatest surprises was that sepsis has now become the greatest cause of maternal death in the UK,”

... the virulent Group A streptococcus organism – is something that is acquired in the community, “in other words, perhaps from children at home who had sore throats”.

... “I would think the causes ranking second and third in Britain – clotting disorders and haemorrhage – would still rank as the number one and two direct causes of death in Ireland with sepsis not as high.”

He describes the finding as “a wake-up call for all of us in the profession . . . you think of sepsis as being more a cause of maternal death in developing countries”.

He says the listing of haemorrhage as one of the top causes of maternal death is also noteworthy, particularly its link to Caesarean sections.

“The more C-sections a woman has had, the more likely she is going to haemorrhage and also the more likely it is on a subsequent pregnancy that the placenta is going to embed itself over the site of the previous scar.

... Other findings in the UK report place emphasis on the importance of caring for the mental health of the mother.

“We know that suicide is one of the fasting growing causes of maternal death,” ...

“We ask every mother at the book-in stage about their history to help identify those who might be more at risk of developing mental health issues throughout the pregnancy or immediately afterwards,” says Ms Hughes. “We put in place referral services for them to mental health or psychiatry services.”

... CMACE will also now record cases where a woman takes her own life in the weeks or months after birth – a step that will, for the first time, highlight the frequency of maternal deaths that occur by suicide ...