MBRRACE: Saving Lives, Improving Mothers’ Care 2019

Published on: 14/12/2019

The report from MBRRACE: Saving Lives, Improving Mothers’ Care 2019 was released yesterday.

During the period of 2015-2017, 209 women died during or up to six weeks after pregnancy of the 2,280,451 who gave birth. The rigorous and confidential enquiry by MBRRACE aims to provide learning from every woman’s death during and after pregnancy for staff, health services and very importantly families left behind.

The leading cause of death for women during pregnancy is heart disease, followed by thrombosis. An important message from the report is regarding severe breathlessness during pregnancy and the fact that this is NOT normal, particularly whilst resting and especially if it happens whilst lying down. Other symptoms to look out for are:

> Severe chest pain spreading to the jaw, arm or back.
> Heart persistently racing.
> Fainting whilst exercising.

Heart disease can occur for the first time during pregnancy. Women who are older, obese, smoke, have diabetes or a family history may be at greater risk.

Whilst the 5th most common cause of death overall, suicide is still the leading cause of death in the first year following pregnancy.

Pre-eclampsia has also been highlighted and the importance of low dose aspirin for those at risk. It is rare for a woman to die from pre-eclampsia, however 2 out of 3 deaths in these cases could have been avoided. This years’ report from MBRRACE along with new guidance from NICE recommends that women at high risk from pre-eclampsia or who have more than one moderate risk factor shown below, should be prescribed 75-150mg aspirin daily and ideally from 12 weeks of pregnancy until birth.

Inequalities in age, ethnicity and geographical area for maternal deaths has been highlighted. Most alarmingly that black women are 5 times more likely to die during pregnancy, or shortly after than white women. Mixed ethnicity women are 3 times and Asian women are twice more likely to die than white women. The report recognises that within these groups, maternal deaths are still uncommon; however the differences are significant and understanding these disparities needs urgent research and action.

Another important message is regarding breast cancer and pregnancy. Any symptoms and in particular unexplained lumps should be checked out straight away, as breast cancer can still develop during pregnancy. Most treatments can still be given and a specialist can assess the ones that that would be most advisable in these circumstances.

The key message of this years report is “Mind The Gap”

As well as the inequalities mentioned above, transitions between services and across systems are key risk points for women and joined up working in these instances is imperative going forward.

The full report along with infographics can be found here.