Other CEMACH studies reported in 2004 and 2005




Why Mothers Die 2000–2002. Report on confidential enquiries into maternal deaths in the United Kingdom

This report, published in November 2004, marked the first 50 years of national reports on confidential enquiries into maternal deaths and the first published following the merger of the Confidential Enquiry into Maternal Deaths (CEMD) and the Confidential Enquiry into Stillbirths and Deaths in Infancy (CESDI). Over the period 2000–2002, the UK direct and indirect maternal mortality rate was 13.1 per 100 000 maternities. This represented a small, but statistically insignificant increase over 1997–1999. The most common cause of direct maternal death was thromboembolism. The most common cause of indirect deaths and the largest cause of maternal deaths overall was psychiatric illness.

This report found that a disproportionate number of women who died were from vulnerable and more excluded groups of our society.

Of the 261 direct and indirect maternal deaths assessed, nearly 50% of cases were classified as having some form of substandard care. This report gives many recommendations for the improvement of clinical care, service provision and interdisciplinary communication and gives essential information to all those involved in the care of women before, during and after pregnancy.




Diabetes Organisational Survey. Maternity services in 2002 for women with type 1 and type 2 diabetes, England, Wales and Northern Ireland

Published in April 2004, the `Diabetes organisational survey' was the first in a series of reports from the CEMACH diabetes programme. Information on the services expected to be provided to women with diabetes before during and after pregnancy was collected from 213 units throughout England, Wales and Northern Ireland. Service provision was evaluated against ten criteria derived from the Diabetes National Service Framework, Scottish Intercollegiate Guideline Network guideline No. 9 and the Consensus Statement of the British Diabetic Association and Association of Clinical Biochemists. Results from this study showed improvements in the organisation of services for women with diabetes including the availability of designated specialist staff. There remained room for improvement in some aspects of services provision with little change in the coverage of multidisciplinary preconception clinics and a significant proportion of units with policies for routine admission of babies of mothers with diabetes in the absence of a specific clinical indication.




Pregnancy in women with type 1 and type 2 diabetes, 2002–2003, England, Wales and Northern Ireland

This report, published in October 2005, on pre-existing type 1 and type 2 diabetes in pregnancy represents the largest study ever undertaken on this topic and includes information on 3808 pregnancies of women with diabetes who delivered or booked in 213 hospitals in England, Wales and Northern Ireland between 1 March 2002 and 28 February 2003. This study shows a continued increased risk of adverse outcomes in babies of women with diabetes compared with babies of mothers in the general maternity population of England, Wales and Northern Ireland. Perinatal mortality was 3.8 times higher and the prevalence of confirmed major congenital anomaly was nearly twice that expected. There was no evidence of a difference in the perinatal mortality in babies born to women with type 1 diabetes compared to babies born to women with type 2 diabetes.

Many women appeared to be poorly prepared for pregnancy with just over one third of women documented as having received prepregnancy counselling or taking folic acid supplementation before pregnancy. Women with diabetes experienced a high preterm delivery rate, high induction rate and a high caesarean section rate compared to women in the general maternity population. One-third of term babies were admitted to a neonatal unit. Two-thirds of these admissions were potentially avoidable, with 26% of all admissions of term babies described as `routine'.

Full copies of these reports and additional information about CEMACH can be found on the CEMACH website: www.cemach.org.uk.