Six maternal deaths recorded in Irish hospitals last year

Six maternal deaths were recorded in maternity hospitals and units in the Republic last year.

New figures published in the HSE’s annual Irish Maternity Indicator System report reveal six women died during 2018 while pregnant or within 42 days of the termination of a pregnancy from a cause related to or aggravated by their pregnancy – four more than the previous year.

The HSE said the maternal death rate last year of 10 deaths per 100,000 mothers was “noticeably higher than recent years”. It was three times the 2017 rate of 3.3 deaths per 100,000 mothers.

It added: “While maternal death in a single year is not considered a robust indicator of quality of clinical care in a maternity setting, lessons can be learnt from the management of individual cases.”

The report, which records data from the country’s 19 maternity hospitals and units, also shows there were 293 perinatal deaths last year – 16 fewer than in 2017. It represents a perinatal death rate which cover stillbirths and deaths within seven days of being born of 4.8 per 1,000 births.

The number of perinatal deaths last year involving babies born without a congenital anomaly decreased by 17 to 56.

The HSE said the rate of perinatal deaths without a congenital anomaly had now fallen by 33.6% since 2014.

It said the data provided national comparisons across all maternity units which allowed hospitals to benchmark themselves against national rates and previous years.

“Since the IMIS was introduced in 2014, there is evidence that the information provided has led to improvements in maternity settings and the quality of care delivered,” the HSE said.

The IMIS reports are prepared by the Office of the National Women and Infants Health Programme and the National Clinical Programme for Obstetrics and Gynaecology.

A total of 61,084 births were recorded last year – an annual reduction of 1.3%. Total births have now fallen 9.4% since the first IMIS report five years ago and by 19.2% over the past decade.

First time-mothers accounted for 38.4% of all births in 2018.

A total of 1,099 women gave birth to two or more babies – a multiple birth rate of 18.3 per 1,000 mothers.

There was a total of 5,098 incidents of what are categorised as “serious obstetric events” last year – an annual decrease of 4.8%.

They included 863 ectopic pregnancies, 21 cases of eclampsia, 11 ruptures of the uterus and 20 women who suffered a pulmonary embolism.

There were four recorded cases of swabs being left unintentionally in the vagina following a vaginal delivery and two cases of a misdiagnosed miscarriage.

The HSE said it followed another two incidents of miscarriage misdiagnosis in 2017 after several years without any such cases.

It described the two cases last year as “disappointing given improvements in early pregnancy assessment units after 2011 and the development of a national training programme and the national clinical guideline “Management of Early Pregnancy Miscarriage” in 2012.”

Six maternal deaths recorded in Irish hospitals last year

The report shows 936 mothers required transfer to a critical care unit or other hospital last year due to a serious obstetric event – a transfer rate of 15.6 per 1,000 mothers.

Blood transfusions were required by 1,562 pregnant women last year – a rate of 26 per 1,000 cases – although the HSE said there was wide variation across hospitals.

The latest IMIS report also show 31 hysterectomies were carried out following birth last year.

The HSE said hysterectomies were rare in modern medicine and were “usually only performed in emergency situations”.

During deliveries last year, 39.4% of women received an epidural and 15% had an instrumental delivery.

The proportion of women giving birth by Caesaran section in Irish maternity hospitals is continuing to increase and reached its highest rate in over a decade last year at 33.8%.

The HSE said the rate of the number of women undergoing inductions of labour had risen in the past five year with 31.5% of all mothers being induced last year with a wide variation in rates between different hospitals.

It said probably explanations for the variations were clinical factors, sociodemographic trends and organisational behaviour and practices.

“There is no known optimum rate of induction of labour,” it added.

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