By Niall Hunter

The Rotunda Hospital says it is looking at improving systems to tackle the diffficult-to-predict but often fatal risk of embolism in some some pregnant women.

As revealed on irishhealth.com today, the Dublin maternity hospital recorded three maternal deaths last year, two of which were due to massive pulmonary embolisms. The Rotunda has now recorded 13 maternal deaths over the past five years.

The Rotunda's Master, Dr Sam Coulter-Smith, said two of the three deaths were from massive pulmonary embolisms, the risk for which can be difficult to predict.

He told irishhealth.com pulmonary embolism was one of the top three causative factors internationally in maternal death. The third death last year was unlikely to have been directly related to pregnancy.

Dr Coulter-Smith said under current systems the embolism deaths could not have been foreseen and the hospital was now planning to launch a thromboembolism risk assessment project to try to detect the risk of this condition in mothers who may appear not to have such a risk on assessment when they first attend the hospital.

He said on initial assessment, some patients may have a low risk for embolism, but in some cases the risk can increase as the pregnancy progresses and new systems were needed so the risk could be recalculated at later stages of the pregnancy.

Dr Coulter-Smith said maternity services needed to get better at assessing this type of risk and this was the idea behind the pilot project.

While 13 maternal deaths over four or five years might seem like a lot, he said specific circumstances were attached to each death and predicting maternal mortality rates was in many senses a 'lottery'. He pointed that over a 48 hour period in 2012 there were two maternal deaths at the Coombe Hospital.

Also, not all of the deaths at the Rotunda in recent years were direct maternal deaths, and causes had included suicide.

Dr Coulter-Smith said the recent number of maternal deaths at the Rotunda were too relatively small to determine whether they could be linked to service or resourcing issues.

He said it was the experience in general with maternity services that certain patient groups, such as non-nationals, did not always access care optimally and there was an over-representation of non-national patients in adverse outcomes such as neonatal and maternal deaths.

Dr Coulter-Smith said services at the Rotunda were continually under pressure, and he had just come from the labour ward, where there were eight women fully dilated.

He said the Rotunda was now looking after 2,500 more women annually than it did 10 years ago and the hospital's infrastructure was not capable of dealing with this demand.

3 maternal deaths at Rotunda last year