We are pleased these are our best ever obstetric results, but we are very concerned about the effects of social class, ethnic differences and domestic violence

Professor James Drife, CEMD

Research also showed black or Asian women had a risk of death that is twice as high as white women.

The main direct causes of death (28%) were thrombosis and thromboembolism and hypertensive disease of pregnancy (pre-eclampsia).

The main indirect cause (36%) was heart disease.

The current total of indirect deaths is the highest ever, the report said.

It also notes that about 12% of those who died had reported domestic violence.

Eight women were murdered by their partner.

Worrying trends

The report found 60% of deaths directly related to the pregnancy had suffered some form of substandard care and 50% had "major" substandard care in which different treatment might have affected the outcome.

The main causes were a lack of communication and team work, a failure to appreciate the severity of the illness and suboptimal treatment, wrong diagnoses and failure of consultants to attend.

The findings are based on 378 reported maternal deaths to the inquiry between 1997 and 1999.

More midwives needed

The CEMD carries out research into individual cases of death of women in the UK during pregnancy or up to a year after birth.

Although the report found the number of maternal deaths to be their lowest ever, experts believe it uncovers some worrying trends.

Clinical director of CEMD Professor James Drife said: "We are pleased these are our best ever obstetric results, but we are very concerned about the effects of social class, ethnic differences and domestic violence.

"While the number of maternal deaths is small, the findings are socially significant."

The CEMD carries out enquiries to identify trends and learn lessons for their prevention.

The National Childbirth Trust (NCT) says the report identifies the pitfalls of a serious shortage of midwives.

Government improvements

The NCT's Mary Newburn said: "These disturbing findings are yet more evidence that the UK desperately needs more midwives to provide the care and support that mothers need during pregnancy and after childbirth.

"Within the maternity services, the most vulnerable families should be provided with social and emotional support from a small group of midwives they can get to know and trust.

"The National Childbirth Trust would like to see more midwives available for at least six to eight weeks after the birth, with the health visitor gradually taking over during this time and providing a similar level of emotional support, as needed, throughout the first year after birth."

The Maternity Alliance says the report is a valuable tool for making improvements across a number of government departments.

The Alliance's director Christine Gowridge said: "There needs to be a cross-departmental response, not just from the Department of Health, but the DSS and the Home Office.

The CEMD report recommends the results should be incorporated into the planning of new models of care, local audit plans and the further development of local guidelines.