Quality in obstetrics and gynaecology: the example of the enquiries into maternal mortality

For nearly 50 years there has been an independent system for monitoring all maternal deaths in the United Kingdom. Validation exercises suggest that about 99% of cases are successfully identified and reviewed. The analysis is published every 3 years and includes independent assessment as to whether substandard care was present. As the proportion of cases where substandard care is present remains constant at about 40-50%, it is claimed that these reports do little to improve the quality of care. Review of particular causes of deaths suggests that the regular stating of the problem areas, developing management guidelines relating to these, and re-auditing practice, almost certainly has improved standards. However, more remains to be done.