Prevention of maternal death: a perspective

Abstract

Although the maternal mortality rate in Hong Kong remains low over the past 43 years, there were five reported maternal deaths in 2021 to 2023. In a cross-sectional study on maternal death events in Hong Kong from 2000 to 2019, the leading causes of direct maternal death were suicide, hypertensive disorders, and obstetric haemorrhage, followed by amniotic fluid embolism, pregnancy-related infection, pulmonary embolism, and cardiac diseases, whereas the leading causes of indirect maternal deaths were stroke and cancer, followed by infection (including hepatitis B virus) and cardiac diseases.

Measures to improve maternal safety include evidence-based safety bundles, team communication and training, integrated multidisciplinary care for high-risk patients, risk-stratified levels of maternal care, and improvements in communication between providers and patients about early warning signs. A review of cases of severe maternal morbidity or near-missed cases may help prevent maternal mortality. The Hospital Authority has set up special maternity care units for monitoring of women with high-risk obstetric conditions by a multidisciplinary team of obstetricians, anaesthetists, and specialised midwives with critical care training. As most unintentional maternal deaths occurred between 6 weeks and 1 year after delivery, there is a need to extend postpartum care beyond the traditional 6-week postpartum period, especially for women with multiple medical conditions, mental health issues, or substance use disorders. Obstetricians should be aware of the causes of and preventive measures for maternal death. Every effort should be made to prevent maternal death.