First national audit on maternal complications in pregnancy published

The first national audit on maternal complications in pregnancy highlights low rates of septic shock and hysterectomy following birth, compared with other countries.

Coming only weeks after the HSE's clinical review into the death of Savita Halappanavar identified a litany of serious failures at University Hospital Galway, the findings of this audit involving 19 of the State's 20 maternity hospitals, should reassure patients, according to the authors.

The audit, which was published yesterday, shows that one in 263 pregnant women experienced a severe maternal morbidity (complication) during labour, delivery and the period following childbirth. The incidence of severe maternal morbidities was disproportionately higher among ethnic minorities.

The perinatal mortality (death of foetus) rate among the group of women with severe maternal complications was 32.6 per 1,000 births – this is substantially higher than the national rate, which was recently estimated at 6.6 per 1,000 births.

The National Perinatal Epidemiology Centre (NPEC), based at University College Cork, carried out the audit of 67,806 maternities, representing 93 per cent of pregnancies in Ireland for the year 2011, in collaboration with the medical and midwifery staff from the individual units.

Major obstetric haemorrhage was the most frequent cause of severe maternal complications identified at a rate of 2.3 per 1,000 maternities, followed by intensive care unit admission, renal/liver dysfunction and peripartum (occurring during the last month of pregnancy or the first few months after delivery) hysterectomy.

There were four cases of septic shock – the cause of Ms Halappanavar’s death – reported, a rate of about 0.06 per 1,000 which is similar to international rates and there were no deaths among those cases.

Prof Richard Greene, director of the NPEC, said: "It's reassuring that the audit findings show the rate of sepsis is not high despite the public perception of sepsis over the last year. The issue of sepsis was highlighted in the last maternal mortality report in the UK as an issue and, of course, we have to keep aware of it and follow the international guidelines for surviving sepsis."

Another important finding of the audit in the context of the Lourdes hospital inquiry was the low rate of peripartum hysterectomy of 0.3 per 1,000 maternities which is similar to findings in previous international studies. The majority of women who required a peripartum hysterectomy had experienced a major obstetric haemorrhage.