Kerala has now initiated a system of maternal near-miss audits in all districts, to analyse the critical events which resulted in near maternal deaths and the vital interventions which helped doctors salvage the situation and save mothers.
Maternal mortality being a crucial indicator of the quality of health systems, the lessons learnt can result in better medical interventions to reduce maternal deaths and promote safe motherhood.
The Health Department is being helped in this initiative by Kerala Federation of Obstetrics and Gynaecology (KFOG), which has now put forth the concept of obstetric rapid response teams (ObRRTs) at all delivery points, to prime the State’s response to catastrophic obstetric events.
For every maternal death, there are at least 10 maternal “near-misses” or 10 women, who go through life-threatening obstetric complications but are saved because of timely interventions.
KFOG, which has been systematically conducting a confidential review of maternal deaths (CRMD), an independent initiative by the obstetricians’ fraternity since 2005 across Kerala, points out that auditing near-misses are equally important as it helps one discern what went wrong and what was done right.
Opportunity
“The reasons for near-misses are not very different from that of maternal deaths. The advantage here is that since the adverse events had a happy ending, doctors are more willing to discuss and analyse the events.
In fact, every near-miss audit provides a better opportunity to think about the circumstances which led to the event and helps us implement new and improved management protocols,” says V.P. Paily, a senior obstetrician and the State coordinator of CRMD.
Since January the maternal death and near-miss surveillance and response (MDNMSR) process has been initiated in all districts across the State, involving both public and private sector hospitals, to evaluate and review near-misses, identify the causes, assess the response of the health system to emergencies, the gaps in the health system and to suggest remedial measures.
“It is not a fault-finding exercise, rather, the focus is on analysing the response to the adverse obstetric event. Our aim is to close the gaps and improve the quality of care and service delivery,” says V. Rajasekharan Nair, a senior consultant obstetrician and one of the key members of KFOG.
Near-miss audit follows the concept of maternal death surveillance and response, as a continuous cycle of identification, notification and review of maternal deaths, followed by actions to improve quality of care and prevent future deaths, propagated by the WHO.
Kerala is perhaps the only State to have acted upon the operational guidelines released by the Union Health Ministry for Maternal Near Miss Review (MNMR) in 2014.
“Since 2017, KFOG has been doing MNMR as a pilot project in five Government Medical Colleges in the State. An year’s data has now been collated and it has been a huge learning experience,” says Dr. Paily
“Most obstetric complications and near-misses have happened because often there is no system in hospitals to facilitate a rapid response. We have been providing emergency obstetric care and life support training for 1500-odd obstetricians in both private and public sector for the past five years,” he says.
