KARACHI, June 11: Obligatory postmortem for all pregnancy- related deaths in the country was strongly felt as despite considerably high maternal mortality rates, the exact cause of such deaths can rarely be determined.

Participants of the programme held at the PMA House, on Tuesday, for the presentation of “Annual Audit Report of Maternal Mortality and Morbidity” pertaining to four of the city hospitals, hoped that the condition would compel the concerned healthcare providers to adopt an extremely cautious approach while handling delivery cases and also improve intervention techniques and skills.

The representatives were from Murshid Hospital, Patel Hospital, Sobhraj Maternity Hospital and Sindh Government Qatar Hospital — two each from public and private sectors. While mentioning a considerable decline in the mortality rates registered during the year 2001, they acknowledged that the exact reasons behind the few deaths at their institutions remained largely unknown.

Dr Shahida Hasan, a senior gynaecologist from Jinnah Postgraduate Medical Centre, Dr Rahat Qureishi from Aga Khan Hospital and Dr Saida Haider, a senior anaesthetist from Civil Hospital, were assigned the responsibility of auditors.

Taking stock of the growing tendency among local gynaecologists to resort to Caesarean section, they reminded that unnecessary sections ultimately compounds the risk of infections and exposes patients to serious complications.

Meanwhile, observing that haemorrhage was mentioned by all the four representatives of hospitals as the major cause of maternal deaths, the auditors recommended concerted programmes to emphasize the importance of nutritional value, besides round-the- clock availability of safe blood transfusion.

The need to bridge the communication gap between doctors and patients and evolve an atmosphere of mutual confidence and trust was also largely felt due to instances when patients suffering from hepatitis were brought in and the concerned healthcare providers did not know about their condition at the time.

Dr Saida Haider, on basis of her experience, reminded that a majority of the patients admitted at the Surgical ICU of Civil Hospital were those who, if adequately taken care of, may not be there at all.

“Fifty per cent of all patients admitted at the ICU are those related to obstetric cases, while we deal with 19 different disciplines,” she observed.

It may be mentioned that all the four hospitals catered to almost a similar number of unbooked cases (one-third).

Keeping in view the high number of unbooked cases generally brought under critical conditions, experts suggested the presence of well-experienced and qualified staffers at the nearest possible distance.

Since hepatitis was found to be a pertinent cause behind some of these deaths, doctors were advised to keep in view these facts and ensure thorough investigations. Use of magnesium and regular audit meetings at the departmental level were measures strongly recommended to contain preventable deaths.

Earlier, Dr Nighat Shah of Murshid Hospital, presenting the audit report of her institution regarding maternal mortality and morbidity rates, mentioned that half of the 9,500 patients visiting the outpatient department were obstetric cases.

She particularly maintained that 20pc of the patients approaching the hospital were found to have no organic diseases and were presumed to be victims of violence ranging from psychological abuse to physical vehemence.

Of the 250 admissions in the inpatient department of gynae during 2001, reasons for three of the seven deaths was said to remain unconfirmed, while four others were either due to hepatitis, haemorrhage or sepsis.

Four near-missed cases were also cited, which despite being brought in extremely conditions, were saved. One such instance was attributed to delayed arrival to the hospital due to strike and violence on the streets. While others were due to lack of awareness, indifference and indecisiveness on part of the relatives.

Dr Farida Khan of Sobhraj Hospital said that of the 7,137 gynae and obstetric cases, four died while 82 were near misses. The latter were described as instances requiring immediate medical and obstetric care and delay of even half-an-hour may have resulted in death.

Eclampsia, a complication of hypertensive diseases, was cited as one of direct causes of maternal morbidity and mortality.

Samina Saleem of Patel Hospital, in her report related to the period between Feb 2001 to Jan 2002, said that of 295 deliveries, 255 were booked and 40 unbooked.

Dr Aziza Hamza Kapadia of Sindh Qatar Hospital in Orangi Town said that of 2,781 deliveries during a one-year period, 40 appeared to be near-missed while 15 mothers could not survive.—APP