The Confidential Enquiry into Maternal Deaths (CEMD) is a national programme investigating maternal deaths in the UK and Ireland. Since June 2012, the CEMD has been carried out by the MBRRACE-UK (Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries) collaboration, commissioned by the Healthcare Quality Improvement Partnership (HQIP).
The predecessor to MBRRACE-UK, CMACE (Centre for Maternal and Child Enquiries) produced a report every triennium, analysing all maternal deaths from the previous three years divided into topic-specific chapters. Reports are now published on an annual basis, with each report focusing on a selection of chapters. Furthermore, each MBRRACE-UK report now contains the Confidential Enquiry into Maternal Morbidity (CEMM), a study focusing on women who survived severe pregnancy problems, with the topic chosen in an open application process. The 2014 CEMM topic was maternal sepsis.
The most recent report by the CEMD (and the first by MBRRACE-UK) was published in December 2014, and focused on deaths from AFE, sepsis, haemorrhage, deaths from neurological complications, and deaths from other medical and surgical complications between 2009 and 2012. During the time that the Confidential Enquiry into Maternal Deaths has existed, there has been a fall in overall maternal deaths in the UK, with rates having fallen from 90 per 100,000 women giving birth in 1952 to around 10 per 100,000 at present.
Maternal deaths
According to the United Nations Maternal Mortality Estimation Inter-agency Group, which consists of representatives from the World Health Organization (WHO), United Nations Children's Fund (UNICEF), the United Nations Population Fund (UNFPA), United Nations Population Division, the World Bank and world-renowned academics, maternal death is:
"The death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and the site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes".
In addition, a late maternal death is one which occurs more than six weeks but less than one year after the end of pregnancy. Maternal deaths can be further divided by cause, typically into: direct deaths, resulting from obstetric complications of the pregnant state (e.g. amniotic fluid embolism, pre-eclampsia); indirect deaths, resulting from medical or medical health conditions exacerbated by pregnancy (e.g. cardiac disease) or coincidental deaths, where the cause is unrelated to pregnancy (e.g. RTA, homicide).
The CEMD reports on all maternal deaths in the UK and Ireland, including those that are late and/or coincidental.
History of the CEMD
The current system of confidential enquiries began in 1952, however, the history of smaller, local enquiries dates back to 1917 in Aberdeen, with national enquiries across England, Scotland and Wales following in the 1920s and 1930s. Maternal deaths during this period were particularly prevalent in poor, working-class families, thus a large part of these early local enquiries was focused on the social backgrounds of the women who died. Further emphasis was placed on educating women and their families on the importance of maternity care as well as an understanding of the warning signs of complications and the importance of seeking help.
Due to the large number of births taking place in non-clinical settings, avoidable clinical factors were not the only consideration. There was an emphasis on the need for health care workers to improve hygiene standards and ensure training in the use of forceps, and to ensure deliveries requiring other forms of intervention were undertaken in hospital. These local enquiries, along with various medical advances (notably the introduction of antibiotics) were credited with a sharp decline in maternal deaths in the 1930s and 1940s.
In 1952 the Ministry of Health instituted the national confidential enquiry for both England and Wales, initially to reports its findings on a three-yearly basis, and since 2014 on a yearly basis. Since its inception, the overall aims of the enquiry have been:
To save more women's and newborns' lives, to reduce complications, and to improve the quality of maternity services for the benefit of all pregnant women, their infants, and their families. Through the use of guidelines and recommendations, to help ensure that all pregnant and recently delivered women receive the best possible care, delivered in appropriate settings in a way that takes account of, and meets, their individual needs.
