The prevalence of acute medical problems developing in pregnancy and in the postpartum is increasing. This is in part due to the changing demographic and lifestyle factors of the pregnant women, mothers are delaying childbearing until later in lifer and older mothers are at increased risk of complications such as cardiac disease and venous thromboembolism. Advances in management for those with chronic health conditions has also led to an increased risk of higher risk pregnancies. As chronic disease is better controlled and life expectancy increases, people who were previously advised to or chose not to conceive are now choosing to embark upon a pregnancy.
The last national confidential enquiry into maternal deaths (MBRRACE) reports just over half of maternal deaths were due to indirect causes. On review of the individual cases, problems often occurred when people deviated from the normal management pathways for acute medical problems. One of the key messages from the MBRRACE report 2023 is:
Treat pregnant, recently pregnant, and breastfeeding women the same as a non- pregnant person unless there is a very clear reason not to.”
MBRRACE 2023
Pregnant and postpartum women may present to a variety of different health services such as primary care, emergency departments, acute medicine or maternity departments. Aside from pregnancy related problems they can also present with acute medical problems such as chest pain, breathlessness, fevers, palpitations, headaches and seizures. Clinicians should use reputable resources when assessing these patients. The resources below should help with the assessment, investigation an management if these patients. We strongly advise early MDT discussions and escalation to your local maternity and medical teams.
The emphasis should be on making a diagnosis, not simply excluding a diagnosis”
Knight, Nair et al. 2016
