Dr Sudha Jasmine Rajan1, Dr Sowmya Satyendra1, Dr Audrin Lenin1, Dr Jiji Mathews2, Dr Santhosh Benjamin2, Dr Reeta Vijayaselvi2, Dr Anuja Abraham2
1Department of Medicine 3 and Obstetric Medicine, Christian Medical College, Vellore, Vellore, India, 2Department of Obstetrics, Christian Medical College, Vellore, Vellore, India
Biography:
I am a physician at a 3,844-bed university teaching hospital, ranked as the country's third-best teaching and tertiary care institute with almost 3 million outpatients, 661,000 inpatients, and 13000 deliveries each year with countrywide referrals. My colleague and I started Obstetric Medicine Services in 2015.
https://orcid.org/0000-0003-4852-9301
Scopus Author ID: 36141108600
Abstract:
India has one-fifth of the childbirths in the world annually, with nearly 24000 maternal deaths. Half of maternal mortality is due to indirect causes of medical problems during pregnancy (1). The impact of maternal deaths is immense, and children born to these mothers have almost 50 times higher risk of dying within the first year of their life (2.3). We aimed to find the impact of Obstetric Medicine services on maternal mortality in the institution.
On July 1st, 2015, an obstetric medicine clinic and referral service, with training and research, was started in a university teaching hospital with almost 13000 deliveries/ year. Thrice weekly, physician-run clinics, alongside 24*7 referral services and training of medical and obstetric residents in the management of these disorders, were started. Therapy was standardized through contextual protocols from standard guidelines for common medical disorders in pregnancy. Multidisciplinary meetings are held to plan and manage complex medical problems.
The maternal mortality ratio in the institution reduced to 1/3 within 6 months of the start of service, from 150-200/100000 live births (1) to <50/ 100000 live births. 80% of maternal deaths were referrals of critically ill patients from other hospitals. The sharp decline was largely due to a reduction in indirect causes. The MMR has remained around 50, excluding a spike during the COVID-19 pandemic in 2021.
Feedback from the obstetricians, obstetric, and medicine residents was encouraging. They said it improved their knowledge and skills and sensitized them to new learning that they did not realize existed.
Trust, teamwork, and collaborations between physicians, subspecialists, and obstetricians save mothers' lives and yield high dividends to society.
Keywords
Maternal Mortality, Obstetric Medicine
References
1.Halder A, Jose R, Vijayselvi R. Maternal mortality and derivations from the WHO near-miss tool: An institutional experience over a decade in Southern India. J Turk Ger Gynecol Assoc. 2014 Dec 1;15(4):222-7. doi: 10.5152/jtgga.2014.14076. PMID: 25584030; PMCID: PMC4285210.
2.Lawrence, E.R., Appiah-Kubi, A., Lawrence, H.R. et al. “There is no joy in the family anymore”: a mixed-methods study on the experience and impact of maternal mortality on families in Ghana. BMC Pregnancy Childbirth 22, 683 (2022). https://doi.org/10.1186/s12884-022-05006-1
3.Moucheraud C, Worku A, Molla M, Finlay JE, Leaning J, Yamin A. Consequences of maternal mortality on infant and child survival: a 25-year longitudinal analysis in Butajira Ethiopia (1987-2011). Reprod Health. 2015 May 6;12 Suppl 1(Suppl 1):S4. doi: 10.1186/1742-4755-12-S1-S4. Epub 2015 May 6. PMID: 26001059; PMCID: PMC4423767.