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St James’ University Hospital, Leeds, UK
To the Editor:
This excellent editorial is correct in noting that between 1991 and 1993, estimates of under-reporting of maternal deaths in the UK were put at 30% (1). With the 1994–1996 Report on Confidential Enquiries into Maternal Deaths in the United Kingdom (2), there has been a change. Previously, only the primary cause of death on the death certificate was coded and computerized. By adapting a program developed in the US, the Office of National Statistics is now able to code and search for all causes of death mentioned on the certificate. A search intended to identify all conditions that might be linked to pregnancy identified 67 (31%) additional deaths unknown to the Enquiries.
There are two points of interest arising from these data. The first is that the lost reports have a larger impact on the figures for indirect and late deaths, and least on direct deaths, where anesthetic interest chiefly resides. The second point is that nine out of the ten unreported direct deaths resulted from thromboembolism.
The clear inferences are that missed deaths will underplay the importance of thromboembolism, and studies such as that of Panchal et al. (3), despite the difficulties that exist with data collection, are probably describing an accurate picture of anesthesia. The incidence of thromboembolic deaths may serve as one index of underreporting.
Footnotes
Dr. Birnbach does not wish to respond.
References
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