Early recognition and response to life-threatening complications in women with severe perinatal mental illness

South London
Start Date: 1 Jun 2016 End Date: 31 May 2019

Over the last 50 years, there has been a significant decrease in the UK in the number of women who die as a result of pregnancy or birth. However, over the last 10 years, the number of maternal deaths caused by health problems not directly related to pregnancy or birth has remained stable.

One of the leading causes of these deaths is mental illness.

‘‘One in five women who die in pregnancy have a mental illness, and one in four postnatal deaths are due to mental health problems,’ says Abigail Easter, a researcher in our maternity and women’s health team.  ’

Abigail is undertaking a three-year King’s Improvement Science fellowship to study how healthcare professionals can improve and implement safer maternity care for women who experience mental ill health. Because deaths during pregnancy or after birth are rare, she will be concentrating on ‘near misses’ – severe and life-threatening complications or events experienced by pregnant or postnatal women.

‘There are lots of systems in place to monitor maternal “near misses” in relation to physical health, such as postpartum haemorrhage or preeclampsia, to understand how to improve care, but nothing currently exists to help identify and learn from maternal “near misses” linked to mental health,’ says Abigail. She plans to study the circumstances surrounding these ‘near misses’ and to use the information she collects to identify how to improve and implement safer maternity care for women with mental illness.

Reviewing existing guidance, published research and medical practice

In the first part of her study Abigail will review current guidance and checklists for identifying maternity ‘near misses’ and the published research on maternal deaths to see how mental health is taken into account. At the same time, she will try to understand how psychiatric maternal ‘near misses’ are being recorded, interviewing a sample of around 35 health professionals and managers working with pregnant women and new mothers with mental illness.

Establishing the extent of the problem and contributing factors

In the second part of her study, Abigail will examine the electronic health records of women who have had contact with secondary mental health services to determine the extent of the problem in a population of women with severe mental illness. She will also try to identify the factors which might have influenced why these near miss events occurred, such as delayed referral times to specialist care.

Working with a team at the NIHR Maudsley Biomedical Research Centre, at King’s College London and South London and Maudsley NHS Foundation Trust (SLaM), Abigail will analyse three linked sets of data, searching for information about women who had mental health problems and experienced a ‘near miss’ or who died in or after pregnancy between 2007 and 2013.

What next?

Abigail aims for her research to feed into the development of new national indicators to monitor maternal health conditions, ensuring that mental health is formally taken into account for the first time. She also wants to develop a toolkit to help health professionals identify and respond to clinical deterioration among pregnant or postnatal women with mental illness.    

The project was adopted by CLAHRC South London in November 2016. It is expected to complete in May 2019. 

Dr Abigail Easter