What we can learn from the MBRRACE rapid report
The MBRRACE-UK collaboration’s ‘Saving Lives, Improving Mothers’ Care rapid review: Learning from SARS-CoV-2-related and associated maternal deaths in the UK was recently published. The report aims to address the immediate concerns about the impact of the infection on pregnant and postnatal women, identifying lessons learned to guide future care and NHS changes.
Key points and recommendations:
- Between 1 March and 31 May 2020, over 160,000 women gave birth in the UK.
- Substantial inequalities remain for black, Asian and minority ethnic (BAME) communities including higher risk or adverse outcomes both from COVID-19 and other causes of maternal mortality.
- Clinicians need to be aware of this increased risk and have a low threshold for admission of BAME women to ensure they receive the appropriate assessment and specialist care.
- All women (pregnant and postnatal) who have COVID-19 must receive better joined-up care from midwives, physicians and obstetricians. Where pregnant or postnatal women are admitted to A&E or other general hospital areas with COVID-19, maternity teams should be informed immediately and involved in their care.
- Perinatal mental health services are essential to maternity care, even in the context of service changes due to COVID-19.
- All women should be considered for antiviral or other specific therapies for COVID-19 as part of routine care.
- Women with COVID-19 infection should receive information on their risk of deterioration and when to seek urgent medical attention or go to the hospital.
- Interpreting services should be used when necessary.
- Ensure good communication with partners and families is maintained. Ensure facilitation of visits between critically ill women and their partners is a priority.
Cause of mothers deaths:
- Ten women died with SARS-CoV-2 infection (all the eight women who died from COVID-19 were in the third trimester of pregnancy at the time of disease onset).
- Four women died by suicide.
- Two women died as a result of domestic violence.
Inequalities in maternity:
Seven of the ten women who died from COVID-19 were from BAME backgrounds.
As part of the ongoing maternity safety strategy, the RCM is lobbying for action to address the inequalities in maternity by calling for more specialist midwives to care for women who have greater needs to improve health outcomes.
Specialist midwifery roles include roles with a focus on perinatal mental health, smoking, obesity, teenage pregnancy, asylum-seeking and refugee women, traveller women, female genital mutilation, substance misuse, homelessness, and bereavement. The RCM is calling for more specialist caseload teams focussing on providing continuity of carer to BAME women to seek to address the growing health inequalities.
In many parts of the UK, specialist midwife roles do not exist or are very limited. This means many women who need additional support may not receive the right care.
Numbers per 100,000:
- The estimated SARS-CoV-2-associated maternal death rate is around six per 100,000.
- Maternal mortality due to suicide during or up to one year after pregnancy is just over two per 100,000.
- Mortality due to murder during or up to one year after pregnancy was one woman per 100,000 giving birth.
Death rates in standard MBRRACE reports are reported over three years; therefore the deaths reported in this rapid report do not indicate a statistically significant increase in the overall maternal mortality rate in the UK at this stage.