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Christopher B-Lynch


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Why Mothers Die 2000-2002: Report On Confidential Enquiries Into Maternal Deaths In The United Kingdom. CEMACH

Among the eight women who sought care, there were elements of substandard care in seven. Most aspects of substandard care have been discussed earlier in this chapter, but one further point deserves discussion.

Recent changes in medical training may be relevant to the increased numbers of deaths from haemorrhage. Reduction in overall length of obstetric training and in working hours during training may have reduced the amount of experience gained. There is also a trend towards subspecialisation among consultants and thos with a special interest in obstetrics do not necessarily have highly developed surgical skills. The information available to the Enquiry does not permit any firm conclusion as to whether these factors contributed to the recent change in death rates. If they did contribute, this would strengthen the recommendation for regular ‘fire drills’ or ‘skills drills’ for management of obstetric emergencies, including major haemorrhage, for all grades of staff in every unit.

Obstetric haemorrhage: learning points

• Catastrophic haemorrhage is a persisting problem.
• All of the women who dies with placenta praevia had previous caesarean sections.
• Women at high risk of haemorrhage are still delivering in isolated or units ill-equipped to sudden, life-threatening emergencies. These units may be without immediate access to specialist consultant care, blood products or intensive care.
• Women who decline blood products should be treated with respect and a management plan in case of haemorrhage agreed with them before delivery is anticipated.
• During this triennium, two women who concealed their pregnancies for fear that their babies might be taken into care died of postpartum haemorrhage at home.
• Obstetric care was considered to be substandard in 12 out of 15 (80%) of cases where the woman had sought treatment; anaesthetic care was considered to be substandard for five (see Chapter 9).
• No deaths were reported in women who had had interventional radiology or B-Lynch suture.

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B-Lynch Suture Published Press Articles

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