Deaths of pregnant women 'preventable'

BY RUTH HILL AND KATE NEWTON
Last updated 05:00 21/11/2009

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Five of 11 women who died from complications of pregnancy could have been saved with better communication and prompt medical intervention, a Health Ministry report has found.

Poor management of high blood pressure, a lack of co-operation between health professionals caring for women with complex medical problems, and problems for non-resident women in accessing care have been cited as avoidable factors in fatal cases.

The Perinatal and Maternal Mortality Review Committee has issued its report on maternal and perinatal deaths – babies who die after 20 weeks in the womb and up to 28 days after birth – for 2007.

The committee's chairwoman, Cindy Farquhar, professor of obstetrics and gynaecology at Auckland University, said though survival rates for mothers and babies had improved since 2006, it was impossible to read a trend from two years' data.

"That's the point of having an in-depth analysis of every case, so we can see if there are lessons to be learned."

Successive enquiries have blamed turf fights and mistrust between doctors and midwives as factors in the deaths of mothers and newborns.

Five pregnant women died from "indirect" causes, such as surgery, psychiatric illness and family violence, one death could not be categorised, and another three were ruled "coincidental" and not included in the final tally.

Two women died in road crashes – neither was wearing a seatbelt – and one from cancer.

The report also examined the deaths of 677 babies between January 1 and December 31 – nearly two a day.

International evidence suggested many stillborn babies could have been saved if they had been monitored more closely during pregnancy, Professor Farquhar said.

However, about one in four babies' deaths in New Zealand remain unexplained, with only 39 per cent of stillbirths and 40 per cent of neonatal deaths "optimally investigated".

"It's a traumatic time for families and sometimes they say no to a post-mortem, but then after they go away and think about it, they want to know what happened."

Poverty was the biggest risk factor for dying as a baby. Babies born to mothers in the most-deprived 20 per cent of the population were 1.5 times more likely to die compared with babies born into the most-privileged homes. "This suggests we need to target services to make access to antenatal care easier."

The 29 recommendations include: establishing a national perinatal epidemiology unit, highlighting clinical areas of concern such as bleeding in pregnancy and detecting small babies before birth, developing national guidelines for safe sleeping environments, and improving public awareness of wearing a seat belt during pregnancy.

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Blood was not provided

Among the deaths to be included in the next report is that of Renee Bayliss, whose death sparked two inquiries into Auckland Hospital services.

Ms Bayliss, 33, haemorrhaged just after giving birth to daughter Allix in January 2008, but it took three hours for Auckland Hospital staff to start giving her blood transfusions, despite being asked to have cross-matched blood ready.

Allix, now 22 months old, survived.

The hospital apologised to Ms Bayliss' partner, Nick Blackley, and her family after an independent inquiry found her death was preventable.

Her mother, Wendy Bayliss, told The Dominion Post in February that Auckland Hospital had killed her daughter.

"There is no other way around it. She had requested blood be put aside for her and it was not done."

The hospital's internal investigation resulted in changes to its process for obtaining emergency blood, improving handover procedures between staff and checking all pregnant women for risk of post-birth haemorrhage.

KEY FINDINGS

* 16.8 per 100,000 pregnant women died in 2007, down from 23 per 100,000 in 2006

* 10.3 babies per 1000 died, compared with 12.4 in 2006

* 10 deaths of healthy newborns associated with unsafe sleeping practices

* 32 per cent of stillbirths from 24 weeks' gestation and 41 per cent of full-term stillbirths unexplained

- The Dominion Post

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