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Maternal near misses in perinatal mental illness

Maternal deaths have been systematically studied in the UK for over 50 years, at both local and national levels. While there has been a significant decrease in the number of maternal deaths due to direct causes (i.e. attributed to pregnancy or birth), deaths resulting from indirect causes (i.e. attributed to coexisting conditions) have remained stable over the last 10 years. Mental illness remains a leading indirect cause of maternal death.

In developed countries such as the UK, where maternal deaths are rare, it is becoming increasingly recognised that studying near misses (or severe life-threatening complications not resulting in death) can provide important additional information about the processes, or lack of, in place for recognising and responding to clinical deterioration and help guide interventions aimed at improving patient safety.

Several frameworks and checklists for identifying maternity and obstetric near misses exist. Despite the high proportion maternal deaths relating to mental rather than physical health, these frameworks focus almost entirely on physical health indicators (such as sepsis and postpartum haemorrhage), with limited consideration psychiatric indicators.

In order to identify near miss events among women with perinatal mental illness there is a need for a national framework that includes both physical and psychiatric indicators of clinical complications.

A two phase study is being undertaken to develop and pilot a framework for identifying near miss events in women with perinatal mental illness. Qualitative interviews and focus groups will be conducted with key stakeholders (patients and clinicians) to guide the development of the framework. A mixed methods study of electric health records of women who have had contact with secondary mental health services will then be undertaken to test its feasibility and determine rates of near miss events in a population of women with severe mental illness. A qualitative study of patients notes be undertaken to explore the contextual influence on detection and response to maternal near misses and deaths among women with severe perinatal mental illness.

In the future, we aim to test the framework at a national level and to develop an implementation toolkit to aid identification and response to clinical deterioration among women with perinatal mental illness.

This study is being undertaken by Dr Abigail Easter (Senior Research Fellow in Implementation Science) as part of a King’s Improvement Science Postdoctoral Fellowship. The project is supervised by Professor Louise Howard, Professor in Women’s Mental Health, Consultant Perinatal Psychiatrist and Head of the Section of Women’s Mental Health and Professor Jane Sandall, Professor of Social Science and Women's Health in the Division of Women’s Health.

The work of King’s Improvement Science is funded by King’s Health Partners (Guy’s and St Thomas’ NHS Foundation Trust, King’s College Hospital NHS Foundation Trust, King’s College London and South London and Maudsley NHS Foundation Trust), Guy’s and St Thomas’ Charity, the Maudsley Charity and the Health Foundation.

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