Professor Catherine Nelson-Piercy
Guy’s and St. Thomas’ Hospitals Trust
Globally around 800 women die every day in pregnancy or up to 42 days post partum. This represents a maternal mortality ratio (MMR) of 223 maternal deaths per 100,000 live births. This is a long way off the UN Sustainable Development Goal target 3.1 to reduce the global MMR to less than 70 deaths per 100000 livebirths by 2030.
The global MMR fell by 35% between 2000 and 2020 (from 342 to 223 deaths per 100000 livebirths to 223 deaths per 100000). However, during the period 2016–20, MMRs were static in 133 countries, and increased substantially in 17, mainly in western Europe, North America, Latin America, and the Caribbean. Both the US and the UK have reported increasing MMRs, with higher rates in Black, Asian and Hispanic women, older women and those with more social deprivation. The low MMRs in Australia and New Zealand (3 and 8 per 100000 respectively) continue to fall slowly.
In the UK there has been a significant increase in the maternal death rate from 8.79 /100,000 in 2017-2019 to 11.54 / 100,000 in 2000-2022 (RR 1.53, 95% CI 1.26-1.85, p<0.001). These figures do not include the deaths from COVID-19. Deaths from COVID-19 can be prevented with vaccination but continued robust unambiguous proactive vaccine endorsement, with consistent clear communication is required.
For the first time in more than twenty years pulmonary embolism is the leading cause of maternal death in the UK followed by COVID-19, cardiac disease and psychiatric disease. This is despite aggressive thromboprophylaxis. More than half of all women who die have medical comorbidities and a third are obese; a third of the women had had two or more previous caesarean sections and over two fifths did not receive the recommended schedule of antenatal care. In over half the cases assessors felt the death of the mother was preventable. Late maternal deaths that occur between 42 days and one year post partum are mainly due to psychiatric causes, malignancy and cardiac disease. Lessons from the medical causes of maternal deaths in the UK including endocrine and neurological causes will be discussed.
References
Hoyert DL. Maternal mortality rates in the United States. National Center for Health Statistics Health E-Stats. 2021. https://www.cdc.gov/nchs/data/ hestat/maternal-mortality/2021/maternal-mortality-rates-2021.pdf (accessed March 28, 2023).
Munira Z. Gunja, Evan D. Gumas, Relebohile Masitha, Laurie C. Zephyrin. Insights into the U.S. Maternal Mortality Crisis: An International Comparison. The Commonwealth fund, 2024.
Knight M, Bunch K, Felker A, Patel R, Kotnis R, Kenyon S, Kurinczuk JJ (Eds.) on behalf of MBRRACE-UK. Saving Lives, Improving Mothers’ Care Core Report – Lessons learned to inform maternity care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2019-21. Oxford: National Perinatal Epidemiology Unit, University of Oxford 2023. ISBN: 978-1-7392619-4-8
Asma Khalil et al., “A Call to Action: The Global Failure to Effectively Tackle Maternal Mortality Rates,” Lancet Global Health 11, no. 8 (Aug. 2023): e1165–e1167.