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92 Maternity and Obstetrics 2020 | NMH Annual Rep t I n keeping with changes to reporting of information, vignettes will no longer be included in this chapter. Maternal Mortality There were no maternal deaths in 2020. There was one late maternal death (>42 days postnatal, <1 year postnatal) due to metastatic carcinoma diagnosed in pregnancy. Severe Maternal Morbidity There are four contextual points to make for 2020 • The COVID-19 pandemic had an effect on the rate of sepsis • Regarding the apparent increase in the rate of Massive Obstetric Haemorrhage (MOH), fibrinogen was used as a standard treatment for any woman with blood loss greater than 1l due to concerns regarding blood supplies. This only applied for three months during the first lockdown from April to June 2020 and therefore reflects an artificially high rate of MOH. • There was a reduction in the rate of peripartum hysterectomy, • There was an increase in the rate of eclampsia: each case was reviewed individually and also discussed within the multidisciplinary 'Grand Rounds', with ongoing education within the hospital across all disciplines and teams. Data is compiled from a number of sources including the High Dependency Unit Record, Pathology Department, Placenta Accreta Spectrum Service, Haematology Team, Maternal Medicine Clinic, Microbiology Department as well as referral Intensive Care Units and Interventional Radiology teams. In early 2021, data from 2020 was again presented at a hospital wide Grand Rounds in order to share learning points for future care and confirm completion of data. I wish to acknowledge the work of Dr Fionnvola Armstrong, Dr Eoghan Mooney, Dr Paul Downey, Dr Susan Knowles, Ms Jacinta Byrne, Ms Celine O'Brien and Ms Fionnuala Byrne in compiling and confirming the validity of this information. The NMH reports all SMM to the National Perinatal Epidemiology Centre for inclusion in a National Severe Maternal Morbidity (SMM) report. Additionally, in 2020 the NMH participated in the second year of a national audit of Diagnosis and Management of Pulmonary Embolism in Pregnancy. Maternal M tality/Severe Maternal M bidity Morbidity 2018 Major SMM only* 2019 Major SMM only* 2020 Major SMM only* Major Obstetric Haemorrhage 33 13 33 Uterine Rupture 2 1 1 Peripartum Hysterectomy 8 9 3 Eclampsia 1 0 4 Renal / Liver Dysfunction 1 3 7 Pulmonary Oedema 2 2 0 Acute Respiratory Dysfunction 1 1 0 Pulmonary Embolism 2 3 2 Cardiac Arrest 0 0 0 Coma 0 0 0 Cerebral Vascular Accident 0 1 0 Status Epilepticus 0 0 1 Septic Shock 4 4 6 Anaesthetic Problems 0 0 1 ICU/CCU admission 3 1 0 Other 1 (Anaphylaxis) 1 (DKA) 3 (1 DKA, 2 anaphylaxis) Interventional Radiology 2 3 0 Total 52 42 61 * Data from January 1 st 2020 to December 31 st 2020; some women had more than one SMM – in this table only the major SMM is reported