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Confidential Enquiry into Maternal and Child Health. Improving the health of mothers, babies and children. www.cemach.org.uk. Julie Maddocks North West & West Midlands Regional Manager for CEMACH Supervisor of Midwives [email protected] Brief overview. Non-NHS organisation

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slide1

Confidential Enquiry into Maternal and Child Health

Improving the health of mothers, babies and children

www.cemach.org.uk

Julie Maddocks

North West & West Midlands Regional Manager for CEMACH

Supervisor of Midwives

[email protected]

brief overview
Brief overview
  • Non-NHS organisation
  • Funded mainly by NPSA
  • Central Office in London
  • 7 Regional offices in England, affiliated offices in Wales and N Ireland
  • Strong support by clinicians
    • Panel assessors and chairs
    • Advisory group members
work programme
Work programme
  • Maternal and perinatal surveillance
    • Maternal deaths during pregnancy up to 1 year
    • Late fetal losses from 22 weeks, stillbirths and neonatal deaths up to 28 days
  • Child health
    • Children from 28 days to 18 years old
  • Topic-specific projects related to morbidity
approach
APPROACH
  • Mortality Surveillance
    • Mothers to one year after delivery
    • Babies from 22 weeks gestation to 28 days
  • Topics
    • Descriptive study
    • Organisational survey
    • Clinical audit
  • Trust-specific feedback
    • Trust specific work
slide9

Note: due to high variance in rates calculated using events numbering less than five, data presented in the graph are for trusts with 1000 or more live births and 5 or more deaths in 2005. The national stillbirth rate has been adjusted accordingly

slide10

Note: due to high variance in rates calculated using events numbering less than five, data presented in the graph are for trusts with 1000 or more live births and 5 or more deaths in 2005. The national neonatal mortality rate has been adjusted accordingly

perinatal enquiry
Perinatal Enquiry
  • National Reports
  • Regional Reports
  • Trust specific Reports
  • Trust specific work

Topic Work

  • Diabetes and pregnancy
  • HIE
diabetes in pregnancy
Diabetes in pregnancy
  • 3876 babies over 18 months
  • Findings so far:
    • Stillbirths 5x, neonatal deaths 3x, major malformations 2x
    • T2 more common than expected; outcomes as bad
    • Preparation for pregnancy very poor
    • Preconception services haven’t improved
    • Low breastfeeding rates
    • Separation of mother and baby
diabetes and pregnancy nw dissemination educational programme 2008
Diabetes and PregnancyNW dissemination/educational programme 2008

Interactive workshops

“Translating recommendations into practice”

22nd January 2008

17th September 2008

Seminar

“Translating recommendations, research and guidelines”

24th June

Lancashire Cricket Club

helping to implement recommendations
Helping to Implement Recommendations
  • Joint RCGP/Diabetes UK leaflet to GPs and primary care team
  • Interactive workshops
    • Extended case studies
    • Translating findings into practice
  • Collaborative research projects
    • Barriers to accessing diabetes preconception care
    • BEADI project
a new title a renewed purpose
New title

Top 10 recommendations and auditable standards

Near misses UKOSS

GP and EMD chapters

Better statistical rigour

Separate reports for GPs, ED, Path, Psych and Midwives

A new title: a renewed purpose
definition of a maternal death
Definition of a maternal death

A maternal death is a death occurring during pregnancy or within 42 days of delivery, miscarriage, termination of pregnancy or ectopic pregnancy from any cause related to, or aggravated by, the pregnancy or its management.

types of maternal death
Types of Maternal Death
  • Direct
  • Indirect
  • Co-incidental (fortuitous)
  • Late (between 42 -365 days after delivery)
types of maternal death1
Typesof Maternal Death
  • Direct
  • Indirect

= UK Maternal Mortality Rate

telling the story
“Telling the story”

“Whose faces are behind the numbers? What were their stories? What were their dreams? They left behind children and families. They also left behind clues as to why their lives ended so early”.

the maternal mortality surveillance cycle

Identify cases

Implement

Evaluate and refine

Collect information

Recommendations

for action

Analyse the results

The maternal mortality surveillance cycle
direct maternal death rates united kingdom 1985 2005

10

9

8

7

6

Rate per 100,000 maternities

5

4

3

2

1

0

1985-1987

1988-1990

1991-1993

1994-1996

1997-1999

2000-2002

2003-2005

Direct maternal death ratesUnited Kingdom 1985-2005
indirect maternal death rates united kingdom 1985 2005

10

9

8

7

6

Rate per 100,000 maternities

5

4

3

Improved case

Improved case

2

ascertainment

ascertainment

by ONS

by CEMACH

1

0

1985-1987

1988-1990

1991-1993

1994-1996

1997-1999

2000-2002

2003-2005

Indirect maternal death ratesUnited Kingdom 1985-2005
sub standard care
Sub-standard care
  • Lack of clinical knowledge and skills
  • Lack of senior support
  • Poor identification and management of higher risk women
  • Communications
    • Lack of communication
    • Lack of communication skills
    • Telephone conversations
    • Referral letters and information
mortality and deprivation

35

30

25

20

15

10

5

0

Least deprived

2

3

4

Most deprived

Quintile of the Index of Multiple Deprivation 2004

Mortality and deprivation
obesity
Obesity

52% of mothers who had booked for antenatal care died were overweight or obese c/f estimates of 11-10% in the general population.

  • 25% overweight
  • 12% obese (BMI 30-34.9)
  • 15% were morbidly obese (BMI greater than 35)
      • 8% had BMI greater than 40
why an obesity in pregnancy project
Why an obesity in pregnancy project?

There are services and clinical interventions which would help to improve outcomes for women with obesity and their babies

  • Preconception care
  • Multidisciplinary antenatal care
  • Equipment
  • Screening and management of co-morbidities
  • Management of labour and delivery
  • Minimising the risk of complications
what were the questions
What were the questions?
  • What is the prevalence of obesity in pregnancy in the UK?
  • Are health care services appropriately organised for the care of pregnant women with obesity?
  • Are consensus standards of care for obesity in pregnancy being met in the UK?
  • What are the outcomes for women and their babies?
new projects
New Projects
  • Obesity in pregnancy
    • Increased perinatal mortality and congenital anomalies
    • Maternal deaths
    • Significant morbidity e.g. postpartum haemorrhage
  • Neonatal encephalopathy
    • Important contributory factor to medical negligence claims
    • Significant neurological morbidity
    • Intrapartum-related perinatal mortality rate has remained unchanged
working with individual trusts
Working with Individual Trusts
  • Peer review of perinatal deaths
  • Confidential enquiry approach
  • External assessors
  • Report of findings
reports and publications
Reports and Publications

So far: Diabetes and Pregnancy

  • April 2004 : Organisational Survey
  • Oct 2005 : Descriptive Study
  • July 2006 : BMJ Publication
  • Sept 2006 : Primary Care Leaflet
  • Feb 2007 : “Are we providing the best care?”
  • Oct 2007 : Neonatal Enquiry Findings Report

To come:

  • OAA project
  • Leaflet for women of childbearing age with diabetes

Maternal and Perinatal

  • April 2007 : Perinatal Mortality 2005
  • Dec 2007 : Saving Mother’s Lives

To come:

  • Jan 2008 : Perinatal mortality 2006
  • April 2008 : Why Children Die

Available for download from CEMACH website

slide49

Mission

Our aim is to improve the health of mothers, babies and children by carrying out confidential enquiries on a nationwide basis and by disseminating our findings and recommendations as widely as possible

thank you

Thank You

[email protected]

Tel: 0161 276 6837