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The author discusses the first reports coming from the Mothers and Babies- Reducing Risk through Audits and Confidential Enquiries across the United Kingdom (MBRACE-UK). Topics covered include the confused period during the demise of the programme running the Confidential Enquiries into Maternal Deaths (CEMD), the new reporting styles such as the gap between a death and the report, and the causes of the deaths. Also discussed is the importance of the hospital location of the sick mother.

The article presents a story about how a daughter deals with her mother's death, winner of the "Medical Journal of Australia" (MJA) Dr Eric Dark Creative Writing Prize in the medical students category. The author dreams about looking for her mother in hospital corridors and rooms. She receives calls from acquaintances, friends and relatives telling her how great a nurse her mother was. She describes how her father copes with the death of his wife.

Maternal death review (MDR) is an important strategy to improve the quality of obstetric care and reduce maternal morbidity and mortality. MDR provides detailed information on various factors at community, facility, and district levels that influence maternal health outcomes. One of the key challenges is to analyze large volumes of data collected via a paper-based system that uses facility and community level forms. This database continues to expand quantitatively (multiple forms and data elements), which makes analysis of data increasingly difficult for timely management and analysis. The present paper describes the development process involved in linking the paper-based system with an electronic system for MDR in India. The lessons learnt from this experience can contribute to understanding how innovative technologies can be used to address large-scale public health issues in low-resource countries and in particular solutions to address maternal health. [ABSTRACT FROM AUTHOR]

In countries where maternal death review (MDR) sessions are proposed as an intervention to improve quality of obstetric care, training focuses on the theory behind this method. However, experience shows that health staff lack confidence to apply the theory if they have not attended a practical training session. To address this problem, a training curriculum based on the new guidelines from the FIGO Leadership in Obstetrics and Gynecology for Impact and Change (LOGIC) Initiative for preparing and conducting MDR sessions was designed and tested in Cameroon. This curriculum is competency-based and consists primarily of practical individual or group exercises. [ABSTRACT FROM AUTHOR]

The present study aimed to initiate facility based review of maternal deaths and near misses as part of the Ethiopian effort to reduce maternal mortality and achieve United Nations Millennium Development Goals 4 and 5. An in-depth review of all maternal deaths and near misses among women who visited 10 hospitals in four regions of Ethiopia was conducted between May 2011 and October 2012 as part of the FIGO LOGIC initiative. During the study period, a total of 2774 cases (206 deaths and 2568 near misses) were reviewed. The ratio of maternal deaths to near misses was 1:12 and the overall maternal death rate was 728 per 100 000 live births. Socioeconomic factors associated with maternal mortality included illiteracy 1672 (60.3%) and lack of employment outside the home 2098 (75.6%). In all, 1946 (70.2%) women arrived at hospital after they had developed serious complications owing to issues such as lack of transportation. Only 1223 (44.1%) women received prenatal follow-up and 157 (76.2%) deaths were attributed to direct obstetric causes. Based on the findings, facilities adopted a number of quality improvement measures such as providing 24-hour services, and making ambulances available. Integrating review of maternal deaths and near misses into regular practice provides accurate information on causes of maternal deaths and near misses and also improves quality of care in facilities. [ABSTRACT FROM AUTHOR]

Maternal death reviews (MDRs) provide the multidisciplinary maternity care team with a process to conduct in-depth review of the health care and circumstances surrounding maternal deaths. From these reviews, recommendations to improve care in primary, secondary, and tertiary healthcare settings can be made. Practical guidelines and training curricula for MDRs are lacking. To fill this gap, a manual comprising guidelines and tools to help health professionals conduct structured MDRs was developed through the FIGO LOGIC initiative. [ABSTRACT FROM AUTHOR]

This short paper describes some early findings from an overview of the maternal death or severe morbidity “near-miss” reviews that have been undertaken to improve clinical care by the eight societies participating in the FIGO Leadership in Obstetrics and Gynecology for Impact and Change (LOGIC) Initiative in Maternal and Newborn Health aimed at strengthening the role of professional obstetric associations. While it is expected that each will publish its own report, generalizable lessons emerged and valuable solutions were implemented that will help others planning such reviews and audits in future. [ABSTRACT FROM AUTHOR]

The attainment of United Nations Millennium Development Goal 5 has proven elusive for many countries. Efforts to reduce maternal mortality require concerted evidence-based efforts from all key players, including professional organizations. The Association of Obstetricians and Gynaecologists of Uganda used the results of maternal and perinatal death review to develop and pilot advocacy programs with parliamentarians, media, and government that aimed to improve maternal and newborn health in Uganda. This work translated to further parliamentary debate on the topic, increased resource allocation by government, and improved media-related public education. [ABSTRACT FROM AUTHOR]

Strategic advocacy has played a substantial role in the development and implementation of maternal death review (MDR) in Nigeria. Stakeholders that include the Society of Gynaecology and Obstetrics of Nigeria have partnered with the Federal Ministry of Health to ensure a robust arrangement that will guarantee the success of MDR in this country. Consequently, it is envisaged that the program will both contribute to a sustainable reduction in the maternal mortality ratio and promote improvements in maternal health care. The Nigerian experience indicates that the influence of stakeholders, such as professional organizations, is essential to drive the development of MDR programs through provision of advocacy and technical support. The current convergence of factors—including global support, political will, technical innovations, and increased financial resources—provides an ideal opportunity to make MDR a reality for all countries. [ABSTRACT FROM AUTHOR]