Maternal deaths in the UK: pre-eclampsia deaths are avoidable.

582 www.thelancet.com Vol 389 February 11, 2017 Being pregnant in the UK has never been safer. The latest Confi dential Enquiries into Maternal Deaths and Morbidity reported that fewer than one in 10 000 women died in or around pregnancy in the UK during 2012–14 (241 women within the triennium), the lowest rate recorded since such surveillance began in 1952 in England and Wales. This maternal mortality rate is lower than age-matched male death rates (5–17 per 10 000 population for men aged 20–44 years in England and Wales, 2014) such that a man is more likely to die while his partner is pregnant than she is. Several important messages emerge from the latest Confi dential Enquiries into Maternal Deaths and Morbidity: cardiac disease is the leading cause of indirect maternal death, while thrombosis and thromboembolism continues to feature as a major issue and is the leading cause of direct deaths. Suicide is, however, the leading cause of direct maternal deaths within a year after the end of pregnancy. Two-thirds of maternal mortality is due to a medical or mental health condition. Therefore, the need for specialist care for women with pre-existing medical and mental health problems is clearly still a vital concern. In addition to ongoing surveillance of triennial maternal deaths, the report examined deaths related to cardiovascular and hypertensive diseases, early pregnancy problems, and critical care between 2009 and 2014. Indirect maternal deaths, related to underlying conditions exacerbated by pregnancy, are increasingly important and now represent 59% of total maternal deaths; 153 women died from heart disease between 2009 and 2014, representing about a third of all maternal deaths. Specialist multidisciplinary care for women with known heart disease, particularly with prosthetic valves, together with prompt action when women present with chest symptoms or breathlessness remain key to avoiding further deaths. Healthservice provision must also focus on pre-pregnancy counselling, and uptake of contraception and provision of termination services to limit future mortality among women with known heart disease. Other causes of death both indirect and direct (resulting from obstetric complications of pregnancy) have been stable, with the exception of pre-eclampsia, which has substantially reduced since the last report and is now the least represented category (fi gure). Only two women died from pre-eclampsia and eclampsia during pregnancy in the UK during 2012–14. In the previous two reports, there were 19 and ten maternal deaths from pre-eclampsia in 2006–08 and 2009–11, respectively. This reduction is remarkable since hypertensive diseases have consistently been a leading direct cause of death in pregnancy. Maternal deaths from pre-eclampsia have been associated with substandard care, suggesting they are avoidable. In the latest Confi dential Enquiries into Maternal Deaths and Morbidity, fewer than one woman per million women died from hypertensive-related disorders during pregnancy in the UK and there was less than one such death per year. The low rate of maternal deaths from pre-eclampsia in the UK is in stark contrast with the global setting where an estimated 40 000 women die each year from this condition, which equates to about fi ve deaths every hour. The proportion of maternal deaths from hypertensive disorders of pregnancy is 2·8% in the Maternal deaths in the UK: pre-eclampsia deaths are avoidable