Today, MBRRACE-UK publish their latest findings in their Confidential Enquiries into Maternal Deaths 2016 “Saving Lives, Improving Mothers’ Care”.
This report looks at maternal deaths in the UK between 2012-2014 and notes that overall there was no significant decrease in the rate of maternal death in the UK between 2009-2011 (review period for the previous report) and the period 2012-2014. According to the report, the majority of women who died in early pregnancy were due to an ectopic pregnancy and states that, while miscarriage and ectopic pregnancy are common and dealt with every day of the week in the UK, nevertheless women still experience severe morbidity (how often the condition occurs) and some will die as a result of the condition.
The report stresses that ectopic pregnancy should be considered as a possible diagnosis in any woman of reproductive age who presents with collapse, acute abdominal pain or gastrointestinal symptoms, whether she is known to be pregnant or not. In such cases, a pregnancy test should be performed. It is the EPT’s view that the symptoms listed are extreme and are likely to show once a woman has ruptured, leaving surgery as the only option. We seek that ectopic pregnancy be ruled out earlier so as not to get to the point where it is a threat to life and surgery is the only treatment available. We would also urge caution with using urinary pregnancy tests in isolation as they do not necessarily show as positive with an ectopic pregnancy. If there is a negative urinary pregnant test but ectopic pregnancy symptoms we also support the use of hCG blood testing. The EPT considers that all women of childbearing age presenting with abdominal pain and/or bleeding should be considered pregnant until proven otherwise.
While we agree that the full range of clinical and investigatory services to assess women in early pregnancy emergencies should be available throughout the whole week, we stress the need to ensure adequate training and resources are secured to facilitate this.
We welcome the suggestion that paramedics should review protocols for management in the community of collapsed/shocked women of reproductive age and urge that this be expanded to improve pathways for GPs. Many women presenting with symptoms of ectopic pregnancy attend their local GP surgery first and it is crucial to improve processes to diagnose the condition earlier so that a woman’s life is not put at risk.
This review shows that ectopic pregnancy remains the leading cause of death in early pregnancy and, while it has key lessons for early pregnancy care, more needs to be done to prevent loss of life through ectopic pregnancy.