Oxford Handbook of Midwifery (95 page)

• Social disadvantage: women were up to 20 times more likely to die if they lived in families where both partners were unemployed, compared to those from more advantaged groups. Single mothers were three times more likely to die than those in stable relationships.
  
• Poor communities: in the most deprived areas of England, women had a 45% higher death rate compared with women from more affluent areas.
  
• Minority ethnic groups: women from groups other than white were three times more likely to die. Black African women, including asylum seekers and newly arrived refugees, had a seven times higher mortality rate than white women and had problems accessing the service.
  
• Late booking or poor attendance: 20% of the women who died booked for care after 22 weeks, or had missed over four routine antenatal visits.
  
• Obesity: 35% of all the women who died were obese.
  
• Domestic violence: 14% of all the women who died disclosed that they were subject to violence in the home.
  
• Substance abuse: 8% of women who died were substance misusers. The 2007 CEMACH report concluded the following:
  
• 295 mothers died of pregnancy related conditions between 2003 and 2005. Direct causes were thromboembolism, sepsis, pre-eclampsia and amniotic fluid embolism.
  
• There were fewer deaths from haemorrhage, anaesthesia, and trauma to the uterus.
  
• Risk factors for maternal deaths were linked with social exclusion as previously.
  

The CEMACH report
^1,2
has provided an overview of the findings and recommendations specifically related to midwives and their practice. This is intended to stimulate debate on what lessons can be learned from the management of the women who died. There are detailed recommendations on antenatal care and specific guidance for developing ways to meet the needs of women in the above-named groups.

1. Confidential Enquiry into Maternal and Child Health (2004).
   Why Mothers Die 2000–2002.
   

   London: CEMACH. Available at: M
   www.cemach.org.uk (accessed 25.2.11).
   

2. CEMACH (2007).
   Saving Mothers' Lives Reviewing Maternal Deaths to Make Motherhood Safer 2003–2005
   . London: CEMACH. Available at: M
   www.cemach.org.uk (accessed 25.2.11).
   

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CHAPTER 19
Emergencies

Blood tests results during pregnancy, detecting deviations from the norm
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Table 19.3
Haematalogical values during pregnancy: detecting deviations from normal

427

BLOOD TESTS RESULTS DURING PREGNANCY