Quality statement 2: Maternal health – life‑threatening conditions

Quality statement

Women are advised, within 24 hours of the birth, of the symptoms and signs of conditions that may threaten their lives and require them to access emergency treatment.

Rationale

Women are at increased risk of experiencing serious health events in the immediate hours, days and weeks following the birth, some of which could lead to maternal death or severe morbidity. Providing women with information about the symptoms and signs that may indicate a serious physical illness or mental health condition may prompt them to access immediate emergency treatment if needed. Emergency treatment could potentially avoid unnecessary deaths and severe morbidity.

Quality measures

Structure

Evidence of local arrangements to ensure that women are advised, within 24 hours of the birth, of the symptoms and signs of conditions that may threaten her life and require her to access emergency treatment.

Data source: Local data collection.

Process

The proportion of women who are advised, within 24 hours of the birth, of the symptoms and signs of conditions that may threaten her life and require her to access emergency treatment.

Numerator – the number of women in the denominator who are advised, within the first 24 hours, after birth of the symptoms and signs of conditions that may threaten her life and require her to access emergency treatment.

Denominator – the number of women who have given birth.

Data source: Local data collection.

Outcome

a) Incidence of potentially avoidable maternal morbidity and mortality.

Data source: Local data collection. The Maternal, Newborn and Infant Clinical Outcome Review Programme (undertaken by MBRRACE-UK) reports on rates of maternal death and severe maternal morbidity.

b) Women feel informed about symptoms and signs of postnatal life‑threatening conditions.

Data source: Local data collection.

What the quality statement means for different audiences

Service providers ensure that systems are in place for women to be advised, within 24 hours of the birth, of the symptoms and signs of conditions that may threaten their lives and require them to access emergency treatment.

Healthcare practitioners advise women, within 24 hours of the birth, of the symptoms and signs of conditions that may threaten their lives and require them to access emergency treatment.

Commissioners ensure that they commission services that advise women, within 24 hours of the birth, of conditions that may threaten their lives and require them to access emergency treatment.

Women are advised, within 24 hours of the birth, of the symptoms and signs of potentially life‑threatening conditions that should prompt her to call for emergency treatment.

Source guidance

Definitions of terms used in this quality statement

First postnatal contact

The first postnatal contact should occur within 24 hours after the birth.

[Based on expert opinion]

Information provision

The woman should receive accurate, evidence‑based verbal and written information. If the woman is too unwell to receive this information within the first 24 hours after the birth, the information should be discussed once the woman has made a recovery and is able to identify symptoms and signs of life‑threatening conditions in herself. All women should also be provided with a contact number that can be used at any time of the day or night to seek urgent maternity advice (for example, the labour ward triage number).

Symptoms and signs of life‑threatening physical conditions

The following symptoms and signs are suggestive of potentially life‑threatening physical conditions in the woman:

  • sudden and profuse blood loss or persistent, increased blood loss

  • faintness, dizziness or palpitations or tachycardia

  • fever, shivering, abdominal pain, especially if combined with offensive vaginal loss or a slow‑healing perineal wound

  • headaches accompanied by visual disturbances or nausea or vomiting within 72 hours of birth

  • leg pain, associated with redness or swelling

  • shortness of breath or chest pain

  • widespread rash.

[Definition adapted with expert group consensus from NICE's guideline on postnatal care up to 8 weeks after birth, recommendation 1.2.1, table 2]

Symptoms and signs of life‑threatening mental health conditions

The following symptoms and signs are suggestive of potentially life‑threatening mental health conditions in the woman:

  • severe depression, such as feeling extreme unnecessary worry, being unable to concentrate due to distraction from depressive feelings

  • severe anxiety, such as uncontrollable feeling of panic, being unable to cope or becoming obsessive

  • the desire to hurt others or yourself, including thoughts about taking your own life

  • confused and disturbed thoughts, which could include other people telling you that you are imagining things (hallucinations and delusions).

[Definition adapted with expert group consensus from RCOG's Good practice guidance no. 14, section 5]

Equality and diversity considerations

Communication and information‑giving between women (and their families) and members of the maternity team is a key aspect of this statement. Relevant adjustments will need to be in place for anyone who has communication difficulties, and for those who do not speak or read English. Written and verbal information should be appropriate for the woman's level of literacy, culture and language.