UK needs more obstetric physicians to tackle maternal mortality

Authors: Helen Jaques 

Publication date:  12 Aug 2011

More obstetric physicians are needed to tackle a “worrying trend in the causes of maternal mortality” in the United Kingdom, a group of obstetric physicians has said.

Although maternal mortality in the UK has fallen dramatically overall in the past 60 years, the number of maternal deaths in women with preventable or treatable medical conditions such as epilepsy and asthma has increased significantly. Most of these deaths are associated with substandard care, and in one third of cases different care might have prevented the mother’s death.

A rise in the number of obstetric physicians, who specialise in the care of women with pre-existing or new onset medical problems in pregnancy, would help reduce the number of pregnant women who die from medical disorders, said Catherine Nelson-Piercy, professor of obstetric medicine at Guy’s and St Thomas’ NHS Foundation Trust, and her colleagues in London and Oxford (BMJ 2011;343:d4993, doi:10.1136/bmj.d4993).

“The current maternal death figures show a need to involve medical skills,” they say. “An expansion in the number of obstetric physicians would be a positive step towards reducing deaths from medical disorders in pregnancy.”

Most surgical specialties, such as neurosurgery, urology, and cardiac surgery, have medical counterparts, they argue, and the expansion of specialised obstetric anaesthesia was associated with an “impressive” drop in deaths related to anaesthesia during pregnancy.

Every obstetric unit should have access to an obstetric physician in its local maternity network, and the subspecialty should be formally recognised, the authors recommend.

Furthermore, obstetric medicine should form part of the postgraduate training curriculum for GPs and physicians, so that doctors are aware of the possible underlying problems when pregnant women present with seemingly benign medical symptoms such as breathlessness, headache, and abdominal pain.

The Royal College of Obstetricians and Gynaecologists has agreed that more obstetric physicians are needed to support healthcare professionals who deal with pregnancy complications.

“The reason that direct obstetric deaths have reduced over the years is . . . improved organisation of clinical cover and more uniform care through adherence to national clinical guidelines,” said the college’s president, Tony Falconer. “We must ensure that this trend improves through increased senior presence on the labour ward for those patients needing immediate access to such care.”

He added, “The Royal College of Obstetricians and Gynaecologists pioneered subspecialty training in areas of clinical need such as fetal and maternal medicine, and the next step in the evolution of services is to link all these different parts together through networks, which we believe will provide better care, improve outcomes, and drive up quality.”

Helen Jaques news reporter BMJ Careers

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