XXXX : a leading cause of maternal morbidity and mortality.

@entity1 @entity1032 @entity146 @entity204 @entity1445
The Confidential Enquiry into Maternal Deaths 1997 to 1999 finds that @entity146 , and suicide in particular, is the leading cause of @entity204 . Suicide accounted for 28% of maternal deaths. @entity1 also died from other complications of @entity146 and a significant minority from substance misuse. Some of the findings of the Confidential Enquiry confirm long established knowledge about postpartum @entity146 . The findings highlight the severity and early onset of serious postpartum @entity1032 and of the risk of recurrence following childbirth faced by @entity1 with a previous history of serious @entity1032 either following childbirth or at other times. These findings led to the recommendation that all @entity1 should be asked early in their pregnancy about a previous history of serious @entity146 and that management plans should be in place with regard to the high risk of recurrence following delivery. Other findings of the Enquiry were new and challenged some of the accepted wisdoms of obstetrics and psychiatry. It is likely that the suicide rate following delivery is not significantly different to other times in @entity1 's lives and for the first 42 days following delivery may be elevated. This calls into question the so-called 'protective effect of maternity'. The overwhelming majority of the suicides died violently, contrasting with the usual finding that @entity1 are more likely to die from an @entity1445 of medication. Compared to other causes of @entity204 , the suicides were older and socially advantaged. The Enquiry findings suggest that the risk profile for @entity1 at risk of suicide following delivery may be different to that in @entity1 at other times and in @entity1 . None of the @entity1 who died had been admitted at any time to a Mother and Baby Unit and their @entity146 care had been undertaken by General Adult Services. None of the @entity1 who died had had a previous episode correctly identified and none had had adequate plans for their proactive care. The conclusion is that there is a need for both Psychiatry and Obstetrics to acknowledge the substantial risk that @entity1 with a previous @entity146 history of serious @entity1032 face following delivery.
