Doctors urge better tracking of maternal deaths

Cases such as that of a Gatineauwoman who died of a rare pregnancy complication are infrequent in Canada, butobstetricians argue more still needs to be done to prevent such deaths, starting with a national surveillance program.

32-year-old Marie-Jacque Fortindied along with her unborn baby in March 2016 when, at 39 weeks pregnant, she developed an amniotic fluid embolism, a condition where amniotic fluid leaks into the mother's bloodstream.

A coroner noted the condition isoften fatal, but also said if the Hull Hospital had had better emergency procedures in place and training for staff, both mother and child would have been more likely to survive.

"This is the greatest tragedy that we see in medicine, is when a young mother dies in childbirth," said Dr. Jennifer Blake, CEO of the Society of Obstetricians and Gynecologists of Canada.

"It devastates the family. It has such a massive impact," Blake said."The one thing you can never do is be complacent."

Compared to most countries around the world, Canada has very few maternal deaths, according to the World Health Organization. In 2015, it reported seven such deaths per 100,000 live births. However, there's evidence that number is heading up after years of decline, Blake said.

That's one of the reasons the society is pushing for a national surveillanceprogram to review the deaths of women both during pregnancy and up to one year after childbirth. Such a program would help health-care providers spot trends and prevent future incidents, Blake said.

U.K. program has run for decades

The United Kingdom has had such a system in place for decades, and Australia, New Zealand and the United States have followed itslead. The SOGChas been consulting experts in Canada and abroad as well as talking with representatives from Canada's provincial and territorial governments to come up with a plan for a similar program here.

In the U.K.,teamsof reviewers from a variety ofhealth disciplines are dispatched to study maternal deaths.Reports of their collected findings, stripped of information that would identify patients, are released to the public.

Such a system would be especially useful in Canada, Blake said, because the provinces and territories don't keep data in standard ways, and the findings of coroners' reports don't consistently make their way to health-care providers across the country.

The program in the U.K.has revealed mental health problems and violence are factors in some maternal deaths, Blake said.Ideally, a Canadian program would investigate deaths of pregnant women and mothers up to one year after childbirth, she added, which could also include suicides related to post-partum depression.

'Maternity is getting more dangerous'

Dr. Jon Barrett, chief of maternal-fetal medicine at Toronto's Sunnybrook Health Sciences Centre, said the absence of a surveillance program surprised him when he arrived in Canada in 1992.

In the U.K., where he studied medicine, Barrettand his colleagues reviewed reports from that country's surveillance program carefully, he said.

Thatprogram's mandate has also expanded to look at severe morbidity as well as mortality. That's valuable, given the increased risk of pregnancy and childbirth complications posed by women having babies later in life, as well as health conditions such as obesity.

"Maternity is getting more dangerous as time goes on," Barrett said.

In the U.K. it took an act of Parliament to create the national surveillance system, and Barrett said the same could be required here, given the cost and privacy concerns around sharing health information between provinces.