CME Module 3: Confidential Enquiry into Maternal Deaths (CEMD) Next >

 

Introduction : History of the Enquiry

 

The Confidential Enquiry into Maternal Deaths (CEMD) is the longest running example of self-audit in the world. It is not a clinical audit; rather, it is an observational and self-reflective study that identifies patterns of practice, service provisions, and public health issues that may be causally related to maternal deaths. In short, the purpose of the exercise is to learn from errors and improve patient care in the future. Any maternal deaths in the UK must be reported to the government and the health professionals involved are required to provide all details needed.

The first report in the early 1950’s covered only 77% of all the registered maternal deaths; however, by the late 70’s, 99.6% were included. Furthermore, the later report included deaths within one year of delivery or abortion, while in the past this was limited to only 6 weeks post-delivery or abortion. Therefore, at present, maternal deaths are classified into deaths directly related to pregnancy (DIRECT), those due to pre-existing disease aggravated by pregnancy (INDIRECT), those in which the cause was unrelated to pregnancy (COINCIDENTAL), and those occurring after the internationally defined limit of six weeks after delivery but before one year from delivery (LATE).

The deaths attributed to each category are as follows:

  • 106 (28%) were classified as direct
  • 136 (36%) were classified as indirect
  • 29 (8%) were classified as coincidental
  • 107 (28%) were classified as late

Table 1.1, as shown below, summarizes the total number of deaths during the previous 5 reports. It must be remembered that although the numbers appear to be increasing, more cases are being identified by a new statistics computer program. In comparison to the previous report, there has been a small decrease in the combined overall maternal mortality rates (direct & indirect), the direct maternal mortality rate is the lowest of all 5 preceding triennia, and the indirect maternal mortality rate is higher than in any of the preceding four triennia.

 

Table 1. Deaths notified to the Enquiry and rates per 100,000 maternities; United Kingdom 1985-99.

1985-87 1988-90 1991-96 1994-96 1997-99
Type of Death (n) Rate (n) Rate (n) Rate (n) Rate (n) Rate
Direct 139 6.1 145 6.1 129 5.6 134 6.1 106 5.0
Indirect 86 3.8 93 3.9 100 4.3 134 6.1 136 6.4
Direct and Indirect 223 9.9 238 10.1 228 9.9 268 12.1 242 11.4
Coincidental (fortuitous) 26 1.6 39 1.6 46 2.0 36 1.6 29 1.4
Late n/a 48 2.0 46 2.0 72 3.3 107 5.0
Total 249 325 13.7 321 13.7 376 17.1 378 17.8
Total Maternities (n) 2,268,766 2,360,309 2,315,204 2,197,640 2,123,614


n/a = data not collected for this triennium

 

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