• MBRRACE
    Link:www.npeu.ox.ac.uk/mbrrace-uk/reports
    • Latest audit in series, following on from CMACE & CEMACH.
    • Published in December 2014 & examined maternal outcomes from 2009-2012
    • There was a statistically significant reduction in maternal deaths from a previous rate of 11:100,000 to now a rate of 10 in 100,000 (321 total deaths)
      • MAINLY DUE TO REDUCTION IN DIRECT MATERNAL DEATHS
    • Common themes
      • Obesity remains a significant factor
        • 22% overweight
        • 27% obese
      • Maternal antenatal care was still an issue in many cases.
    • Relatively few anaesthetic related deaths (4 directly related to anaesthesia alone
      • 2 due to hypoventilation following GA
      • 2 related to neuraxial anaesthesia (central venous sinus thrombosis, SDH)
      • 2 related to local aanesthesia administration, but causative relationship likelihood felt to be low
    • Maternal deaths
      • Direct
        • As a result of pregnancy, delivery or management of them
        • Causes in order
          • 1. Thromboembolism
          • 2. Genital tract sepsis
          • 3. Haemorrhage
          • 4. Pre-eclampsia
          • 5. AFE
          • 6. Early pregnancy deaths
          • 7. Anaesthesia
        • Pre-eclamptic deaths are down to their lowest level, and there has been improvements in deaths from genital tract sepsis
      • Indirect
        • Development or complication of pre-existing heath disease during pregnancy
        • Commonest causes and accounts for 2/3 of deaths
        • Maternal cardiac disease is the largest single cause of indirect death followed by neurological disease.
        • Psychiatric causes remain a significant cause
        • Influenza was a significant cause, accounting for 1:11 maternal deaths and was largely preventable.
        • Causes (in order)
          • 1. Sepsis (non-genital tract)
          • 2. Cardiac disease
          • 3. Neurological disease
          • 4. Psychiatric disease
          • 5. Indirect malignancies
        • The number of deaths from indirect causes is not being addressed adequately and should be the focus of ongoing care
    • Indirect maternal death rate/100,000
    • Direct (light) & Indirect (dark) deaths
    • Direct maternal death rate/100,000