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J Drife
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Volume 35: Issue 4: 2005




The UK maternal mortality rate is now 13·4 per 100,000 maternities, which is much lower than in the developing world but still too high.  For 50 years in England and Wales the CEMD has published triennial reports, and since 1985 the Enquiry has covered the whole of the UK.  Its latest report, Why Mothers Die
2000–2002,  published  in  November  2004,  includes  106  Direct  (due  to complications  of  pregnancy)  and  155  Indirect  deaths  (due  to  pre-existing conditions made worse by pregnancy).

Since  1997, Indirect  deaths  (which  are  rising)  have  outnumbered  Direct  deaths, which  fell  in  the  1990s.   The  leading  Direct  cause  is  thromboembolism, which accounted  for  30  deaths  in  2000–2002, mainly  in  women  with  predisposing  risk factors  such  as  obesity  or  thrombophilia.  The  leading  Indirect  cause  is  cardiac disease, which led to 44 deaths, including eight from myocardial infarction and eight from  cardiomyopathy.  Obese  women  accounted  for  35%  of  all  maternal  deaths. The increasing tendency to delay pregnancy means that 18% of births are now to women  aged  35  or  over.  Maternal  mortality  in  the  UK  is  related  to  social  class, with the rate among socially excluded women being 20 times higher than that in social  class  1.  Women  from  ethnic  minorities  have  three  times  the  rate  of  the overall population, and the risk among black African women is increased sevenfold.

When late deaths (up to one year after delivery) are included, the overall leading cause of  pregnancy-related  death  is  psychiatric disease, which  accounted  for  60  deaths  in 2000–2002.  Suicide due to puerperal psychosis is usually by violent means and shows no social class gradient. The Enquiry also records Coincidental deaths, among which the  leading  cause  is  murder.  The  11  murders  in  2000–2002, all  perpetrated  by  the woman’s partner, highlight the continuing problem of domestic violence.