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Further Reading

Published online by Cambridge University Press:  05 April 2023

James Owen Drife
Affiliation:
University of Leeds
Gwyneth Lewis
Affiliation:
University College London
James P Neilson
Affiliation:
University of Liverpool
Marian Knight
Affiliation:
National Perinatal Epidemiology Unit, Oxford
Griselda Cooper
Affiliation:
University of Birmingham
Roch Cantwell
Affiliation:
Southern General Hospital, Glasgow
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Summary

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Type
Chapter
Information
Why Mothers Died and How their Lives are Saved
The Story of Confidential Enquiries into Maternal Deaths
, pp. 230 - 240
Publisher: Cambridge University Press
Print publication year: 2023

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There also some other spin-offs from a CEMD which are often not recognised, but very important. The system set-up allows for rapid recognition of complications which are rare but in a large enquiry become apparent, for example the article by Fawcus and colleagues (2016) highlighted the problem of deaths due to bleeding at or after caesarean delivery, which led to an immediate response. The system also can be used to rapidly report on new diseases such as COVID-19. Here the CEMD was able to produce quarterly reports to the ministerial committee working on COVID-19 and highlight for the committee the higher mortality of COVID-19 in pregnancy, putting pregnant women in the high-risk category and stressing their need for vaccination.Google Scholar
Finally, a CEMD is an integral part of the audit cycle. Poor-quality emergency care was identified early as a problem in maternal deaths by the CEMD in South Africa. Thus permission was obtained from Professor Nyncke van den Broek and the Royal College of Obstetricians and Gynaecologists to adapt their ‘Life Saving Skills’ course to South African circumstances. The adapted course, ‘Essential Steps in Managing Obstetric Emergencies’, was tested in South Africa. Twelve of the worst-performing districts were identified using the CEMD. In partnership with the Liverpool School Tropical Medicine and their volunteers, the adapted course was scaled up in these 12 districts such that at least 80% of all healthcare professionals dealing with pregnant women were trained in emergency obstetric care. The impact was assessed using the CEMD of the 12 districts and the control group of the remaining 40 districts. It showed a 39.5% overall drop in mortality, mainly due to reduction in deaths due to complications of HIV infection, but also a 17.5% reduction in direct maternal deaths, mainly those due to obstetric haemorrhage and hypertensive disorders of pregnancy (Pattinson et al. 2019). This is a good illustration of the audit cycle and the part a CEMD plays in it.Google Scholar
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