Every maternity service in England will need to meet new clinical
standards set out by the NHS to significantly reduce the number
of women who die each year during or after pregnancy.
All pregnant women will be offered an early risk assessment for
venous thromboembolism – blood clots that form in deep veins and
are now the leading cause of maternal mortality – before their
first antenatal appointment. Anyone identified as high
risk will be offered thromboprophylaxis (blood thinners to
prevent clots) within 72 hours.
Every woman with epilepsy will have access to a local specialist
team for managing epilepsy in pregnancy, and offered a tailored
plan to help control seizures, including timely access
to medications that are safe to use in pregnancy.
Women will also be routinely assessed for their mental health
with a consistent set of questions and a report provided at their
antenatal appointment and referred to specialist NHS perinatal
mental health if needed so they can get the right support.
Maternal suicides remained the leading cause of
maternal death occurring between six weeks and one year after the
end of pregnancy between 2022-2024, with deaths from psychiatric
causes accounting for 33% of deaths in this period.
Women experiencing a haemorrhage or significant bleeding after
birth will receive care from specialist obstetricians and
anaesthetists sooner, with new guidelines and thresholds for
significant blood loss to be escalated earlier.
Full roll out of these national measures by March 2027 is
expected to reduce the number of deaths caused by blood clots,
strokes, cardiac disease, suicide, sepsis,
obstetric haemorrhage and pre-eclampsia, which account
for 52% of maternal deaths.
Progress against each clinical standard must be presented to NHS
trust boards with escalation to regional and national level if
local delivery does not meet expected plans.
Though maternal mortality in England is rare, the majority
of maternal deaths are caused by medical conditions that
pre-date or develop during pregnancy – such as blood clots and
strokes (17%) and cardiac disease (15%) – that can be missed or
misattributed to pregnancy.
The latest official data found there were 252 maternal deaths
from 2022 to 2024, compared with 257 between 2021-2023.
Of all women who died during or after pregnancy in 2021-23
research shows improvements in care may have made a difference to
the outcome for almost half (45%).
Kate Brintworth, chief midwifery officer for England,
said:
“Every death during or after pregnancy is a tragedy especially
when differences in care may have changed the outcome.
“We still see symptoms of serious medical problems being missed,
especially for Black and Asian women.
“By setting out these clinical standards and holding hospitals to
account we can significantly reduce avoidable deaths and prevent
future tragedies.
“One in five women will have a medical issue during pregnancy,
yet many of these aren't caught early enough – these measures
including more risk assessments in early pregnancy will ensure no
stone is left unturned.”
The new best practice standards form part of the NHS's maternal
care bundle, developed with frontline clinicians, women and
families, and partner organisations including Royal Colleges,
regulatory bodies, professional societies and
charities.
They cover five areas of clinical care associated with the
leading causes of maternal deaths, as identified by
MBRRACE-UK reports.
As part of the measures, facilities within maternity services
will be upgraded with direct telephone lines to maternity staff
to help ambulance crews transfer pregnant women to labour wards
quickly and implement new monitoring for pregnant women so any
deterioration can be acted on quickly. Up to £5 million has
been allocated to NHS trusts this year to buy equipment
and implement the maternal care bundle.
This announcement comes on the back of the roll out of a new
national signal system to stop and spot emerging safety concerns
in maternity wards.
The Maternal Outcomes Signal
System (MOSS) is digital tool which rapidly analyses
data being routinely recorded by maternity teams on wards to spot
whether there are potential emerging safety issues which need
urgent attention and action.
The NHS is committing to publishing the findings from MOSS every
six months, to ensure steps are taking to reduce safety concerns
in trusts which flag them up.
The new clinical standards strengthen the role of 17 Maternal
Medicine Centres – centres of excellence established by
the NHS across England – to help women with pre-existing medical
conditions, or conditions that arise during pregnancy to quickly
get the extra care they might need.
Each specialist hub is led by a dedicated multidisciplinary team,
including at least one obstetric physician – doctors who are
specialists in medical problems and treatments during
pregnancy.
Networks linked to these centres ensure that access to expert
maternal medicine care is available to all women and that every
maternity department is aware of key ‘red flag' symptoms in
pregnancy and have measures in place so women can
be properly assessed.
