Maternal Health (and the three P’s)

Dr Eli Medd

Consultant Obstetrician and Gynaecologist

Plymouth Hospitals NHS Trust

• Maternal mortality in the UK

• Identifying those at risk

• Working together to reduce risk and

optimise care

Per maternal death reported:

250-400 severe morbidity cases needing ICU

Who is at risk? • Existing medical conditions 66%

• Mental health problems 13%

• BMI >30 39%

• Maternal age >40 RR 3.69

• Low socioeconomic class RR 1.44

• Born outside UK RR 1.18

• African ethnicity RR 3.65

The missed opportunities

• Delayed senior medical and obstetric review with lack

of acknowledgement of risk factors

• Inappropriate interpretation of observations during

pregnancy

• Avoidance/delayed imaging

• Avoidance/delayed drug administration

• Lack of communication and advice between senior

clinicians from different specialties

Interventions

• Pre-pregnancy counselling and contraception

signposting

• Multi-disciplinary approach to decision making

• Don’t assume symptoms experienced by a pregnant

woman are due to the pregnancy

• Don’t avoid imaging to establish a diagnosis

• Think about the Three P’s in a pod…

Three P's in a Pod