Association found between medical co-morbities and maternal deaths
Medical co-morbidities, when women have one or more medical conditions, are found to be an important factor associated with direct maternal deaths, suggests a new study published in the British Journal of Obstetrics and Gynaecology. Specific medical co-morbidities such as asthma, autoimmune diseases, inflammatory/atopic disorders, mental health problems, essential hypertension, haematological disorders, musculoskeletal disorders and infections were found to be associated with a higher risk of dying from the conditions included in this study. Medical co-morbidities contributed to 49% of the increased risk of fatality in the study population.
The researchers looked at 135 women who died between 2009 and 2012 and a control group of 1661 women who survived a severe life-threatening complication and examined factors associated with maternal death from direct pregnancy complications. Data from the recent MBRRACE Confidential Enquiry into Maternal Deaths and on women who survived severe complications during pregnancy and childbirth from the UK Obstetric Surveillance System (UKOSS) were used.
The researchers identified six factors found to be associated with maternal death after controlling for other variables. They found that 70% of the increased risk associated with maternal death could be attributed to these factors, the most important being medical co-morbidities, followed by previous pregnancy problems, hypertensive disorders of pregnancy, inadequate use of antenatal care, substance misuse and Indian ethnicity.
The study highlights that uptake of antenatal care was poorer in women with pre-existing medical problems. These findings send out an important message to those involved in antenatal care as it once again highlights the women at risk. It is this group of women which needs extra support and care.
Supporting women to breastfeed could save NHS £40 million a year
A recent study calculated that a potential cost saving of £40 million a year could be made in the NHS if women were supported to breastfeed. This would be achieved by reducing the incidence of common childhood diseases and mothers at risk from breast cancer. Supporting mothers to exclusively breastfeed from birth to 4 months could save at least £11 million annually, by reducing the incidence of three childhood illnesses—gastrointestinal infection, lower respiratory tract infection and acute otitis media. Doubling the proportion of mothers breastfeeding for 7–18 months over their lifetime could save the NHS £31 million by reducing maternal breast cancer rates and increasing quantity and quality of life. These savings are not dependent on increasing current breastfeeding rates, but on helping and supporting women who have already chosen to breastfeed to extend the length of time that they feed their babies. The researchers concluded policy makers should be reassured of ‘rapid return’ on high-quality services to support breastfeeding.
Cervical cancer treatment has no effect on a woman's ability to conceive
A recent systematic review has suggested that the treatment for cervical cancer appears to have no effect on a woman's ability to conceive; however, the risk of miscarriage in the second trimester may be increased.
The systematic review and meta-analysis of 15 studies assessed fertility and early pregnancy outcomes in women with a history of treatment for cervical pre-cancer vs untreated women. The review found no evidence that treatment for cervical pre-cancer adversely affected the chances of conception, and the overall pregnancy rate was higher for treated than for untreated women. However, although miscarriage in the first trimester was similar for treated and untreated women, cervical treatment was associated with a significantly increased risk of miscarriage in the second trimester.
Midwives should be aware of these findings when taking an antenatal booking history from women who have had treatment for cervical cancer.