Saving Mothers’ Lives: the top ten recommendations.
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The ten top recommendations included:
| a. | recommendations about pre-pregnancy counselling | True | |
| b. | professional translators should be available | True | |
| c. | recommendations about the management of sepsis | True | |
| d. | all clinical staff should be trained in the recognition of serious medical and mental conditions. | True | |
| e. | early warning systems for serious illness are needed | False |
Introduction:
“Saving Mothers’ Lives” was published in 2011 by CEMACE.
It covers the years 2006 – 2008.
It made numerous recommendations, but highlighted a top ten.
Which those involved in maternity care “should plan to introduce and audit as soon as possible”.
It pointed out that previous recommendations seemed to have made real differences.
It highlighted the better outcomes for women with VTE and some ethnic minority groups.
An MRCOG essay could be: "Critically evaluate the ten top recommendations made in the 2006 - 2008 Maternal Mortality Report".
This would mean dealing with:
the ten clinical recommendations,
why they were singled out as important,
and the bits most people will forget
the list is not in order of importance: the ten recommendations are viewed as equally important,
the authors of the Report expect both commissioners and providers of services to act on the recommendations,
and the recommendations about baselines and auditable data.
and
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List of the ten key recommendations.
The Report states that the listing does not denote any kind of priority order.
2. Professional interpreter services.
3. Communication and referrals.
5. Clinical skills and training.
6. Specialist clinical care: identifying and managing very sick women.
7. Systolic hypertension requires treatment.
8.
Genital tract infection / sepsis.
9. Serious
incident reporting and maternal deaths.
10. Pathology.
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This was included in the top ten recommendations of the previous Report.
We obviously need to get better at this.
Conditions mentioned were:
It stated that advice about pre-pregnancy counselling should be offered at every opportunity.
Especially as more than 50% of pregnancies are unplanned.
Baselines and auditable standards
The number and % of women who should have been given pre-pregnancy counselling should be:
recorded as a baseline in December 2011
and by the end of 2013.
It states that a national maternity record might help with gathering such information.
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2.
Professional Interpretation Services.
Family members and friends cannot be relied on to provide accurate translations.
The husband who abuses his wife is not going to say much about it if he is the interpreter!
If the interpreter is a friend, relative or member of the same community, there may be failure to provide information, especially if sensitive.
Women need independent, properly-trained translators.
Baselines and auditable standards
There should be information about the existence of a local
service guideline on care for women who do not speak English, including
interpreter services.
The numbers and % of women needing and getting help from professional interpreters:
baseline numbers by December 2011
follow-up numbers by the end of 2013.
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3.
Communication and referrals.
3.1. Pregnant women who need referral to a specialist must have urgent referral.
In some setups routine referral can take weeks or longer.
The Report puts the onus on the referring doctor to make sure that the referral is urgent.
And to keep an eye on the response to the referral to make sure action is forthcoming.
Most GPs and hospital departments do not have "fail safe" mechanisms for doing this.
Midwives and junior doctors must have "a low threshold for referral" to specialists or seniors
The Report also states that such referrals should get "immediate response".
When referral occurs between specialties, should be at a senior level. When rapid referral is required, the senior doctor should use the telephone.
3.2. This stresses the need for good communication among professionals.
Regardless of whether a woman is ‘‘low risk’’ or ‘‘high risk’’.
The GP must be told that she is pregnant.
When information is requested by one professional of another:
the person from whom the information was requested must reply promptly,
and the person making the request must chase things up if there is not a rapid reply.
We are reminded to consider the use of the phone, which the Report says is not "an obsolete instrument".
Baselines and auditable standards
Data is needed on the use of local guidelines that reflect:
the top 10 recommendations
including advice on communications and referrals
the RCOG guideline on the responsibilities of the on-call consultant.
Data is needed on:
the time from referral to being seen when referred for a specialist opinion
the existence of a system to check that women are being seen urgently.
the numbers of women refused referral by commissioners of services.
Baseline data by December 2011.
Follow-up data by the end of 2013.
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4. Women with potentially serious medical conditions require immediate and appropriate multidisciplinary specialist care.
Women with pre-existing physical or
mental disease at the beginning of pregnancy:
1 These women need immediate referral to appropriate specialist services.
W Providers and commissioners of services should look at developing protocols for which conditions need referral.
th
thi This is so obvious that it is almost embarrassing to type it!
th
Pregnant women who develop actual or potential problems:
These women need immediate referral to appropriate specialists as soon as the problem occurs.
And here is another embarrassing message: "referral can take place by telephone contact with the consultant or their secretary".
This is to ensure that the consultant can see the woman or an other specialist can be found it they can't.
Midwives should be able to make direct referrals to obstetric or other consultants.
But should inform the GP.
Baseline and auditable standards
Protocols should be in place to detail which women should be referred to consultant obstetricians for assessment.
Baseline figures by December 2011.
Follow-up figures by the end of 2013.
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5. Clinical skills and training.
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6. Specialist clinical care: identifying and managing very sick women
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7. Systolic hypertension requires treatment.
Attention was drawn to the risks of intracranial haemorrhage with systolic blood pressures of 160 mm. Hg. or above in the 2000-2003 Report
This was “firmed up” into a recommendation that all of these women be given hypotensive therapy in the 2003-2005 Report.
It pointed out that failure to give such treatment was the most serious failing in the management of severe PET.
And that systolic hypertension had also played a part in deaths from aortic dissection.
It quoted a paper suggesting 160 as the appropriate cut-off point for action:
The 2006-2008 Report goes further.
All women with PET and systolic BP ≥ 150 mm. Hg. require "urgent and effective anti-hypertensive treatment in line with the recent guidelines from NICE".
Consideration should be given to beginning treatment at lower values if:
the clinical picture suggests rapid deterioration
more severe hypertension can be predicted.
The target systolic BP after treatment is ≤ 150 mm. Hg.
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8.
Genital tract infection / sepsis.
Such guidelines should be disseminated to Emergency departments, Community Midwives and GPs as well as maternity unit staff.
how to avoid perineal infection by washing hands before:
A number of auditable standards were included and would be invaluable for an essay on the subject:
maternity units to have a local guideline on the identification and management of pregnancy-related sepsis by the end of 2011.
the number and percentage of women who have appropriate antibiotic prophylaxis for:
termination of pregnancy,
PPROM,
Caesarean section,
repair of anal sphincter.
the frequency and completeness of routine postnatal checks in the community compared with the NICE guideline on postnatal care.
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9.
Serious incident reporting and maternal deaths.
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The Report reckoned that
there is need for urgent guidelines on:
obesity in pregnancy,
sepsis in pregnancy,
pain and bleeding in early pregnancy.
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