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Confidential Enquiry into Maternal Deaths (CEMD)

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Confidential Enquiry: BACKGROUND

Confidential enquires into maternal deaths are intended primarily to assess the levels, causes of and contributors to maternal mortality and to learn lessons to address these. A key feature of the method is confidentiality, which is maintained at all levels keeping the women, health care providers and institutions anonymous at all times. Very often, confidential enquiries involve active surveillance of pregnancy-related or maternal deaths.

Confidential enquiries make extensive efforts to identify all maternal deaths. If confidential enquiries are ongoing, they provide useful information on maternal mortality trends.

The United Kingdom has the longest history of confidential enquiry into maternal deaths, dating back to the 1950s. National enquiries, either continuous or undertaken at regular intervals, and sub-national enquiries have also been carried out in Australia, some states in the USA, and in some European countries. Confidential enquiries have been started in parts of Suriname, Malaysia, Israel, Indonesia and South Africa by adapting the United Kingdom methodology. Time-limited enquiries have also been carried out in Jamaica, the Netherlands and Egypt.

Another tool which modifies the traditional CEMD approach is called TRACE (Tracing Adverse and Favourable Events in Pregnancy Care). Developed by Immpact, TRACE differs from CEMD by including cases of severe obstetric morbidity (“near misses”) as well as maternal deaths, by examining favourable as well as adverse factors associated with obstetric care (useful for preserving morale in low-resource health facilities), and by assessing community factors which may have contributed to a maternal death. For more information on TRACE please see the Additional Resources section of this page.

Identification of death

Generally not applicable (only potential pregnancy-related or maternal deaths are reviewed) but may also use a RAMOS approach.

Ascertainment of maternal/pregnancy related status

Varied, and sometimes multiple, sources used to identify and record all potential pregnancy-related deaths.

Existing records for confidential enquiry can include:

Maternal deaths are usually ascertained by medical professionals (with or without diagnostic aids and/or autopsy) or by verbal autopsy.

Advantages:

Limitations:

Measurement requirements:

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World Health Organisation

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Elsevier - Midwifery

British Journal of Hospital Medicine Drife, J (2006) Fifty years of the Confidential Enquiry in Maternal Deaths. British Journal of Hospital Medicine, Vol. 67(3): 121-5.

Hospital Medicine Drife, J (1999) Maternal mortality: lessons from the confidential enquiry. Hospital Medicine. 60(3)3: 156-7.

BJOG: An International Journal of Obstetrics and Gynaecology Godber, G (1994) The origin and inception of the Confidential Enquiry into Maternal Deaths BJOG: An International Journal of Obstetrics and Gynaecology. 101 (11), 946-7.

Bulletin of the World Health Organisation Hussein, J (2007) Improving the use of confidential enquiries into maternal deaths in developing countries. Bulletin of the World Health Organization, 85(1): 68-9.

BJOG: An International Journal of Obstetrics and Gynaecology Rankin J, Bush J, Bell R, Cresswell P, Renwick M (2006) Impacts of participating in confidential enquiry panels: a qualitative study. BJOG;113:387-92

Elsevier - European Journal of Obstetrics and Gynecology and Reproductive Biology Schuitemaker N,  van Roosmalen J, Dekker G, van Dongen P, van Geijn H, Gravenhorst J.B (1998) Confidential enquiry into maternal deaths in the Netherlands: 1983-1992. European Journal of Obstetrics & Gynecology and Reproductive Biology, 79(1): 57-62.

Oxford Journals - International Journal of Epidemiology Salanave B, Bouvier-Colle M-H, Varnoux N, Alexander S, Macfarlane A, The MOMS Group (1999) Classification Differences and Maternal Mortality: a European study. Int J Epidemiol; 28: 64-9

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CEMACH The Confidential Enquiries into Maternal Deaths in the United Kingdom (2002) Why mothers die: 1997-1999: Midwifery summary and key recommendations. London: RCOG Press.

CEMACH

CEMACH Maternal Death Data Collection Form, 2006-2008. CEMACH.

Department of Health, South Africa NCCEMD, National Committee for the Confidential Enquiry into Maternal Deaths (1998) Saving mothers: report on confidential enquiries into maternal deaths in South Africa.

Department of Health, South Africa NCCEMD, National Committee for the Confidential Enquiry into Maternal Deaths (1998) Interim Report on the confidential enquiry into maternal deaths in South Africa.

Ministry of Health, Malaysia Ministry of Health. Evaluation of implementation of the confidential enquiries into maternal deaths in the improvement of maternal health services. Kuala Lumpur, Ministry of Health, 1998.

Immpact

BC Perinatal Health Program British Columbia Perinatal Health Program - Perinatal Mortality Guideline 6
MATERNAL MORTALITY REVIEW

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