Presentation at the Global Maternal Newborn Health Conference, October 21, 2015
Background: Despite supportive policies and programs to reduce Indonesia’s maternal mortality ratio (MMR), the 2012 Demographic and Health Survey indicated an MMR of 359/100,000 live births. Despite visible and notable progress to strengthen facilities and referral systems, case fatality rates in hospitals have not declined. The USAID-funded Expanding Maternal and Neonatal Survival Program collaborated with the Indonesia Obstetric and Gynecological Association (POGI), to conduct a retrospective review of individual charts in selected EMAS-supported hospitals to better understand the contextual factors associated with maternal deaths.
Methodology: Using a set of standardized tools, teams of at least two physicians reviewed individual case records for deaths in 12 targeted hospitals from January-June 2014. In total, 112 individual charts were reviewed and indexed. A team of 24 Ob/Gyns met to discuss and review the 112 indexed cases and case synopses. Based on their clinical interpretation, a final expert opinion was made regarding factors associated with the deaths.
Results: 1. In the majority of cases, deaths occurred in women aged 20-35 years with fewer than three pregnancies. 2. Delays in receiving care was common. The decision to refer was made too late in more than one-third of the cases. In nearly half of cases, delays in providing care and clinical decision-making at the hospital contributed to death. 3. In more than half of the deaths, the course of clinical treatment and care at the hospital was inappropriate or incorrect. 4. The review committee determined that 70% of the deaths could and should have been prevented, and 26% of the deaths may have been prevented with more appropriate care in the hospital.
Conclusions: In lieu of a more formal and comprehensive death review process, it is possible to gain valuable insights retrospectively from individual charts in a relatively short time period.