Abstract

PIP: Medical audits of hospitals improve obstetrics care by identifying and addressing common problems, and by making staff aware of the proportion of maternal deaths that can be avoided and of ways to prevent them. An honest review looks at what could have been done differently in regard to the timing of treatment (prompt), experience of staff (sufficient), and type of treatment (appropriate). Reasons for deficiencies are sought (shortage of supplies, delayed access to operating facilities, unavailability of anesthesia, lack of skilled staff, patient's inability to pay). Although doctors may initially feel threatened, their job satisfaction and prestige improves with the quality of care. To do an audit, one must identify maternal deaths by examination of the details of deaths of reproductive- age women in gynecology, obstetrics, and emergency; complete a record form for each maternal death; hold regular departmental meetings that are kept on a technical and professional level, at which participants are encouraged to ask questions; form a committee that will meet with the staff involved to review all maternal deaths; hold 6-8 meetings/year to discuss specific cases of maternal and perinatal deaths, where doctor's and patient's names are kept anonymous; compile and distribute data on obstetric cases and maternal deaths to all staff; review antenatal care at primary health centers periodically and make weekly visits to provide support on difficult and high risk antenatal cases (Health center staff should be encouraged to visit the hospital to learn about management of pregnancy complications.); and encourage ward nurses to hold meetings every fortnight to discuss nursing aspects of complicated obstetric cases. Such a program was introduced at a small medical college in Baroda, India in 1965; maternal mortality fell by 25% with the improvement in management of obstetric complications.