Maternal confidential enquiries

For the maternal programme, MBRRACE-UK has over 100 expert assessors from various specialty groups who review the care of the women who died in the UK and Republic of Ireland during or up to a year after pregnancy.

Each death is reviewed by assessors in four main areas: pathology, obstetrics, midwifery and anaesthetics. Where appropriate, care is also reviewed by speciality assessors such as psychiatrists, general practitioners and emergency medicine specialists. All reviews have a primary assessor from each specialty and, if specific issues are identified, a second assessor may also review the woman's care.

Assessments begin with a summary of circumstances surrounding the woman's death or illness. Care is then reviewed against guidance from sources such as the National Institute for Health and Care Excellence (NICE) and the Scottish Intercollegiate Guidelines Network (SIGN). Lessons that can be learned from the woman's care and the quality of her care is determined based on the assessor's judgement.

For more information on the roles and responsibilities of MBRRACE-UK assessors, please vist the maternal assessors page.

As part of their review, assessors give their opinion on the quality of care according to the criteria below:

• Good care; no improvements identified
• Improvements in care identified which would have made no difference to the outcome
• Improvements in care identified which may have made a difference to the outcome

Improvements in care may be associated with guidelines, where these exist and have not been followed, as well as other improvements that would normally be considered part of good care but where no formal guidelines exist.

Assessors are also asked to identify whether any woman's death should be flagged as a Cause for Concern for Communication to the Trust Medical Director and Healthcare Quality Improvement Partnership (HQIP). HQIP has a standard protocol for all the Clinical Outcome Review Programmes to escalate major concerns about care where it is clear these concerns have not been addressed at a local level.

After each women's care is reviewed, chapter-writing groups are organised that include representatives from the relevant specialist assessor group. The chapter-writing groups discuss the reviews of all of the women in the UK and Ireland who died from a specific cause of death in a defined three year period.

At the chapter-writing sessions, the expert assessments of each woman's care are examined to identify the main themes and lessons to include in the MBRRACE-UK Saving Lives, Improving Mothers' Care report. The cause of death and classification of the quality of care are also discussed to ensure that all deaths are appropriately categorised.

Lead members of each chapter-writing group draft the confidential enquiry chapters, which are then edited by MBRRACE-UK collaborators and reviewed by all the other group members and editors. If required, chapters may also undergo external peer review. Within the chapters, lessons are linked to existing guidance or past MBRRACE-UK reports to identify areas where there needs to be improved implementation of recommendations. New national recommendations to improve future care are also created based on lessons identified through the confidential enquiry process. These recommendations are directed at national organisations including the Royal Colleges, NICE, NHS England and the governments of Wales, Scotland and Northern Ireland who have the power to implement any areas for improvement identified by the confidential enquiry process.