Maternal, Newborn and Infant programme: Saving Lives, Improving Mothers’ Care 2020 report

Reports | Published: 14 Jan 2021

This report – Saving Lives, Improving Mothers’ Care: Lessons learned to inform maternity care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2016-18 –  is the seventh MBRRACE-UK annual report.

It includes surveillance data on women who died during or up to one year after pregnancy between 2016 and 2018 in the UK. In addition, it includes Confidential Enquiries into the care of women who died between 2016 and 2018 in the UK and Ireland from epilepsy and stroke, general medical and surgical disorders, anaesthetic causes, haemorrhage, amniotic fluid embolism and sepsis. The report also includes a Morbidity Confidential Enquiry into the care of women with pulmonary embolism. Surveillance information is included for 547 women who died during or up to one year after the end of pregnancy between 2016 and 2018.

The report finds that:

  • cardiac disease remains the leading cause of women’s deaths during and after pregnancy
  • almost three quarters of women who died during pregnancy or up to six weeks after pregnancy in 2016-18 had a pre-existing physical or mental health condition
  • there has been a statistically significant increase in maternal mortality due to Sudden Unexpected Death in Epilepsy (SUDEP). One of the major findings when reviewing the care of these women was the low proportion whose medications were optimised either before or during pregnancy
  • Thrombosis and thromboembolism remains the leading cause of direct maternal death during or up to six weeks after the end of pregnancy
  • maternal suicide remains the leading cause of direct deaths occurring within a year after the end of pregnancy.

The majority of recommendations are drawn directly from existing guidance or reports and denote areas where implementation of existing guidance needs strengthening. In a small number of instances, actions are needed for which national guidelines are not available, and these are presented separately for clarity.

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Maternal, Newborn and Infant programme: Saving Lives, Improving Mothers’ Care 2020 report