Maternal Death ReviewNeed for taking it up

For obstetricians & mid wives ….

• Maternal mortality is not about statistics• Its about women with names, faces

- faces seen with agony, distress, despair - faces that continue to live in the memories and haunt our dreams

Not because these women died in their prime lives, die at a time of expectation and joy, it’s a terrible way to die

But above all because……

……because almost every maternal death is an event that could be avoided and should never have been allowed to happen

Dr. Mohamoud FathallaAssuit University,Egypt

Causes of Maternal Deaths

Medical Causes 1. Direct obsteric causes

- Hemorrhage - Infection - Obstructed labour - Hypertensive disorders - Unsafe abortion

2. Indirect obsteric causes

Contributory Causes

Why are maternal deaths

happening?

The Three Delays

Delay in deciding to seek careDelay in deciding to seek care

Delay in reaching the medical facilityDelay in reaching the medical facility

Delay in receiving adequate care at the facilityDelay in receiving adequate care at the facility

The Three Delays

Delay in deciding to seek careDelay in deciding to seek care

Delay in reaching the medical facilityDelay in reaching the medical facility

Delay in receiving adequate care at the facilityDelay in receiving adequate care at the facility

Three delays leading to maternal death

Delay -1: Delay in decision making • Delay in recognizing the need for health care

• Lack of knowledge of danger signs • Delay in deciding to seek formal care

– Women’s low social status– Lack of economic resources– Preference for traditional care– Other responsibilities, etc.

Three delays leading to maternal death

Delay -2:Delay in reaching the appropriate health facility Arranging money for transportation and health careLocating the transport Knowing where to goDistance to the appropriate facilityInfrastructure for transporting the patient – bad or no roads etc.

Three delays leading to maternal death

Delay -3:Delay in receiving quality care in the institution

• Inadequate resources at the facility• Health personnel, supplies, equipment• Inappropriate treatment and referrals

Averting Maternal Deaths…

• Avoiding maternal deaths is possible even in resource poor countries, but it requires the right kind of information on which to base programmes

• Each maternal death or case of life threatening complication has a story to tell and can provide indications on practical ways of addressing the problems

Why MDR is introduced?• Maternal Death Review (MDR) as a strategy has been

spelt out in the RCH –II National PIP.

It is an important strategy to improve the quality of obstetric care and reduce maternal mortality and morbidity.

• MDR provides detailed information on various factors - that are needed to be addressed to reduce maternal deaths.

• Analysis of these deaths can identify the delays that contribute to maternal deaths at various levels and the information used to adopt measures to fill the gaps in service.

Maternal Death Review

• Should have a mechanism to identify both the medical & contributory causes

• Maternal death reviews should seek only to identify failures in the health care system.

• A commitment to act on the findings of these reviews is key to reduce the MMR

• Should never be used for litigation, punishment or blame. No name – no blame principle

Different Approaches of MDR

• Community based maternal death review

• Facility based maternal deaths review

• Confidential enquiries into maternal deaths

• Surveys of severe morbidity(near miss)

• Clinical audit

Community Based Maternal Death Review

A method of investigation of maternal deaths using a tool- Verbal autopsy to find out the medical causes and ascertaining the personal, family or community factors that may have contributed to the deaths.

Verbal autopsy – interviewing people who are knowledgeable about the events leading to the death such as family members, neighbours, traditional birth attendants etc.

Scope of CBMDR

• Identify both medical and contributory causes leading maternal deaths

• Community and family members perception about the quality and access to health care

• Community level barriers (delays) can be identified

• Health education to create awareness for seeking care

Facility Based Maternal Death ReviewFacility Based Maternal Death Review

A qualitative in depth investigation of the causes and of circumstances surrounding maternal deaths occurring in health facilities

Scope of FB MDR

• Identify circumstances under which the death took place

• Identify causes of death: direct obstetric, indirect obstetric and non obstetric cause.

• What steps are required to prevent such deaths in future:

– Action related to infrastructural strengthening– Action required to augment human resource availability – Action required to develop protocols and strengthen

competence of staff– Supplies and equipments– Demand side interventions to address first and second delays– Management interventions– Other interventions based on the findings of MDR

Advantages of MDR

• Identify the gaps in the existing health care

delivery systems • Identify priorities and plan for intervention

strategies • Reconfigure health services