Meeting the community halfway to reduce maternal deaths? Evidence from a community-based maternal death review in Uttar Pradesh, India

Registration (within first trimester)

Physical examination (weight, blood pressure, abdominal examination)

Ensuring consumption of iron-folic acid (IFA) tablets (100 IFA for all pregnant women or 200 IFA for pregnant women with anemia)

Essential lab investigations (Hb%, pregnancy test, urine for albumin/sugar) including blood grouping and pH typing, wet mount

Assured referral linkages for complicated pregnancies and deliveries

Management and provision of all emergency obstetric and newborn care for complications other than those requiring blood transfusion or surgery

Linkages with nearest Integrated Counseling and Testing Centre/Prevention of Parent-to-Child Transmission (ICTC/PPTCT) Centre for voluntary counselling and testing services

Blood cross matching

Management of severe anemia

Management of complications in pregnancy referred from BEmONC

Normal delivery with use of partograph

Active management of third stage of labor

Identification and referral for danger signs

Pre-referral management for obstetric emergencies (eclampsia, postpartum hemorrhage, shock)

Assured referral linkages with higher facilities

Episiotomy and suturing cervical tear

Assisted vaginal deliveries (outlet forceps, vacuum)

Stabilization of patients with obstetric emergencies (eclampsia, postpartum hemorrhage, sepsis, shock)

Round-the-clock maternal care services

Management of obstructed labor

Surgical interventions such as cesarean section

Comprehensive management of all obstetric emergencies (pregnancy-induced hypertension/eclampsia, sepsis, postpartum hemorrhage, retained placenta, shock)

In-house blood bank/blood storage center

Referral linkages with higher facilities including medical colleges

Neonatal resuscitation

Warmth

Infection prevention

Initiation of breastfeeding within an hour of birth and exclusive breastfeeding thereafter

Screening for congenital anomalies

Weighing of newborns

Antenatal corticosteroids to the mother in case of preterm babies to prevent Respiratory Distress Syndrome (RDS)

Immediate care of low birth weight (LBW) newborns (>1800 g to <2500 g)

Round-the-clock newborn care services

Care of very LBW newborns (<1800 g)

Minimum 6 hours' stay post delivery

48 hours' stay post delivery and all postnatal services for days 0 and 3 for mother and baby

Counseling for feeding, nutrition, family planning, hygiene, immunization, and postnatal check-up

Home visits on days 3, 7, and 42 for mother and baby

Additional visits for the newborn on days 14, 21, and 28

Additional visits may be necessary for LBW and sick newborns

Stabilization of mother with postnatal emergencies (postpartum hemorrhage, sepsis, shock, retained placenta)

Timely referral of women with postnatal complications

Referral linkages with higher facilities

Timely identification of danger signs and complications and referral of mother and baby

Clinical management of all maternal emergencies such as postpartum hemorrhage, puerperal sepsis, eclampsia, breast abscess, postsurgical complication, shock, and any other postnatal complications such as RH incompatibility

Warmth

Hygiene and cord care

Identification, management, and referral of sick neonates, LBW, and preterm newborns

Care of LBW newborns (<2500 g)

Zero day immunization–OPV (oral polio vaccine), BCG (bacille Calmette-Guerin for tuberculosis), Hepatitis B

Care of LBW newborns (>1800 g to <2500 g)

Referral services for newborns <1800 g and other newborn complications

Management of sepsis

Newborn care in district hospitals through Sick Newborn Care Unit (SNCU)

Management of complications

Care of very LBW newborns (<1800 g)

Establish referral linkages with higher facilities