Royal College of Anaesthetists responds to MBRRACE-UK’s Confidential Enquiry into Maternal Deaths and Morbidity

The Royal College of Anaesthetists welcomes the latest MBRRACE-UK report on the Confidential Enquiry into Maternal Deaths and Morbidity, which was published on 14 January.

The report shows that between 2016 and 2018 in the UK, 217 women died in pregnancy and up to six weeks postpartum, giving a rate of 9.7 per 100,000 maternities.

This is a slight but non-statistically significant increase from the previous triennium, showing that there is still room for improvement. The increased maternal mortality amongst women from Black and Asian ethnic backgrounds compared to those of white ethnicity persists, but has decreased slightly.

It is disappointing that assessors concluded that over half of the reported deaths might have been prevented with improvements in care, and that recommendations from previous reports had still not been acted upon.

One of the new recommendations of this report is that a mechanism for dissemination of learning should be established. The RCoA will work with other organisations including the Obstetric Anaesthetists’ Association, the Association of Anaesthetists, the Academy of Medical Royal Colleges and the Royal College of Obstetricians and Gynaecologists to implement this and other recommendations.

The new recommendations with greatest relevance to anaesthetists relate to: the management of major obstetric haemorrhage, to the management of women receiving anticoagulation, particularly where neuraxial anaesthesia is planned, and to the care of women during recovery after surgery. In particular, it is noted that where point-of-care testing is used to assess coagulation, anaesthetists should have training in the appropriate use, and interpretation of results, of such tests.

An overarching theme is that being pregnant or recently pregnant must not adversely affect care and the same standards apply to pregnant as to the non-pregnant population. For anaesthetists, our role as part of the multidisciplinary team and as peripartum physicians is emphasised, echoing themes from the Ockenden report.

Dr Felicity Plaat, RCoA Council member and RCoA representative for obstetric anaesthesia, commented:

 “Overall there are few new lessons to be learned: we need to pay attention to those from multiple previous reports. We still have a way to go before maternity services truly become ‘an organisation with a memory’ but we are committed to making that journey”.