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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…