Maternal Deaths – Why Have They Risen?

Maternal deaths have significantly increased according to the latest data from MBRRACE-UK – an organisation which investigates the deaths of women and babies during pregnancy or shortly after. Their annual report published this month called 'Saving Lives, Improving Mothers' Care' details that between 2020 and 2022, 13.56 women per 100,000 in the UK died during pregnancy or up to six weeks after pregnancy. The report covers a wide variety of concerns and makes new national recommendations to improve care.

Two particular issues stand out to me:

The first is that blood clots are said to account for 16 per cent of the deaths that are recorded by MBBRACE - meaning that ‘thrombosis and thromboembolism is now the leading cause of maternal death in the UK’. This is extremely worrying and it is clear that more must be done to ensure women at risk are identified early and are properly managed.

The second relates to the entrenched inequalities within maternity mortality and the ongoing concerns around language barriers.

Here I look at both of these matters in some more detail.

Blood clots in pregnancy

Venous thromboembolism (VTE) is an umbrella term used to describe deep vein thrombosis (DVT) and pulmonary embolism (PE). A DVT is a blood clot in one of the deep veins in the body, usually in the leg. A PE occurs if such a clot detaches itself and travels to the lungs. This can be fatal and it is important that a DVT is diagnosed and treated as soon as possible.

The risk of VTE is increased in pregnancy and up to six weeks after giving birth. Symptoms of PE can include difficulty breathing and pain or tightness in the chest or upper back.  Symptoms of DVT can include pain, swelling and tenderness in one leg. In terms of treatments, where a DVT is identified during pregnancy then heparin may be prescribed. This is an anticoagulant used to thin the blood. Other treatments may also be prescribed or recommended such as prescription compression stockings.

According to the MBRRACE report, one in four of the women who died from VTE were in the first trimester of pregnancy.  Shockingly, the report predicts a probable increase in VTE related deaths as ‘the current maternity population becomes increasingly complex’. It references the fact that being overweight or obese, as well as being of advanced maternal age are risk factors for VTE.

The report sets out that several women who died from VTE ‘were denied or received inappropriate imaging and treatment because they were pregnant’. It further details that it found ‘evidence of confusion in when and how to use venous thromboembolism (VTE) risk assessment tools and interpret a woman’s risk score’.

MBRRACE calls for more research to restructure the current national VTE risk assessment tool to ensure that it is easy to use, clear and accurate. The report recognises the need for women at risk to be able to access thromboprophylaxis (treatment to reduce the risk of DVT / PE) when it is required, particularly in the first trimester, as well as the need to ensure that GPs can obtain timely specialist advice.

If symptoms of a DVT or PE are missed, or treatment is negligently delayed and someone is harmed or dies, then a legal claim for clinical negligence may be possible.

Entrenched inequality and language barriers

The MBBRACE report underlines inequalities in maternal mortality with ‘a nearly three-fold difference in maternal mortality rates amongst women from Black ethnic backgrounds and an almost two-fold difference amongst women from Asian ethnic backgrounds compared to White women’.

Women living in the most deprived areas were noted to have a maternal mortality rate twice that of women living in the least deprived areas.

The report details that from the review undertaken it was clear that many women who had recently arrived in the UK did not understand how to access maternity services. Many of them booked late in pregnancy and several women presented for the first time at an emergency department. It was further noted that ‘most women did not receive adequate support for their language needs throughout their care, as these needs were not regularly documented and professional interpreter services were not available at many interactions including both scheduled visits and in emergency situations’.

In addition, there were many instances of written information, including consent forms and discharge materials, being provided in English ‘with no apparent consideration for the woman’s level of English or overall literacy’.

In my view, the importance of pregnant women being able to understand the treatment options they face cannot be overstated. At Kingsley Napley, we act in cases where informed consent has not been properly obtained for medical treatment and as a result a patient has been harmed. We further act in situations such as where, due to a failing, a patient has not properly understood the medical advice provided to them, leading to injury. The legal position in such cases can be very complicated. More information in relation to a lack of informed consent can be found here.

MBBRACE have recommended that digital maternity records include details of language needs ‘including the use of formal interpreter services, to ensure that these are taken into consideration at all interactions, including in emergency situations’.

Protecting pregnant women and their babies must be tackled with the utmost urgency and I hope that all of the recommendations in this latest report can be swiftly actioned.

Further information

If you have any questions regarding this blog, please contact Katie Dean in our Medical Negligence & Personal Injury team.

About the author

Katie Dean is an Associate in the Medical Negligence & Personal Injury team having recently completed her training contract at Kingsley Napley. She has experience in litigating a range of cases including birth injuries, ophthalmic injuries, misdiagnosis and fatal accidents.