The death of a woman who is pregnant is doubly tragic, resulting in loss of two lives or, at a terrible minimum, the risks of prematurity or a motherless upbringing. In the UK, regular audits of maternal and neonatal mortality over 60 years have aimed to minimise the risk to mothers and babies. The most recent was published in late 2014 from the Maternal, Newborn and Infant Clinical Outcome Review Programme produced by MBRRACE-UK (Mothers and Babies: Reducing Risks through Audits and Confidential Enquiries across the UK). These data highlight the need for changing the structures of care or pregnant women with pre-existing neurological conditions as well as those with neurological complications of pregnancy.

The confidential enquiries into maternal mortality began in 1952, initially just for England and Wales, with later versions including Scotland and latterly the Republic of Ireland. The most recent report covers the 3 years from 2009. The process involves classification (table 1) and expert assessors’ scrutiny of maternal deaths. Any deficiencies in care identified are rated on whether or not they affected outcome.

Ascertainment rates and data collection rates are now exceptionally high, the …