Editor Dilip Kumar Dutta MD PhD MAMS FICOG FIMCH MAAGL MAFS
Diploma in High Risk Pregnancy (USA) Diploma in Pelviscopic Surgery (Germany) Director, Gice Hospital
Kalyani, Nadia, West Bengal, India
Email: drdilipdutta@yahoo.com
Foreword Hema Divakar
A FOGSI Publication
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© 2012, Federation of Obstetric and Gynaecological Societies of India (FOGSI)
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Insight Maternal Mortality – An Indian Facebook
First Edition: 2012
9789350257968
Printed at
5
UN Secretary Speaks
The Global Strategy for Women's and Children's Health–2010 Launched by UN with a pledged commitment of over 40 billion US Dollars for Women's and children's Health. UN Secretary–2010
President of USA Speaks
Supportive Leadership
We are united in our determination to prevent unwanted pregnancies, reduce the need for abortion and support women and families in the choices they make. Barrack Obama, January 22, 2009
7CONTRIBUTORS
- Amitava Pal
- Associate Professor
- Obstetrics and Gynecology
- Burdwan Medical College
- Burdwan, West Bengal, India
- Anis Akhtarkhavari
- Internee
- GB Pant Hospital, Port Blair
- Andaman and Nicobar, India
- Anuja Singh
- Senior Resident
- Obstetrics and Gynecology
- VMMC and Safdarjang Hospital
- Delhi, India
- Anupama Dave
- Associate Professor
- Hospital and MGM Medical College
- Indore, Madhya Pradesh, India
- Ashish Kumar Bhattacharya
- Professor and Head of Department
- Obstetrics and Gynecology
- Silchar Medical College
- Silchar, Assam, India
- Banashree Das
- Professor
- Obstetrics and Gynecology
- VMMC and Safdarjang Hospital
- Delhi, India
- Bharti Sahu
- Assistant Professor
- Member, Maternal Mortality
- Review Committee
- Madhya Pradesh, India
- Chanakya Das
- Professor and Head
- Obstetrics and Gynecology
- Guwahati Medical College
- Guwahati, Assam, India
- Chanam Manglem Singh
- Professor and Head
- Obstetrics and Gynecology
- Regional Institute of Medical Sciences (RIMS)
- Lamphel, Imphal, Manipur, India
- Dilip Kumar Dutta
- Director
- Gice Hospital, Kalyani, Nadia
- West Bengal, India
- Gita Guin
- Associate Professor
- Nodal Officer, JSY, NSCB MCH, Jabalpur
- Member, Maternal Mortality
- Review Committee
- Jabalpur Division
- Madhya Pradesh, India
- Indranil Dutta
- Junior Resident
- Kalyani, Nadia
- West Bengal, India
- Indu Chawla
- Senior Gynecologist
- CHS, MOH and FW
- Andaman and Nicobar, India
- Khumanthem Pratima Devi
- Registrar
- Obstetrics and Gynecology
- Regional Institute of Medical Sciences (RIMS)
- Lamphel, Imphal, Manipur, India
- L Ranjit Singh
- Professor
- Obstetrics and Gynecology
- Regional Institute of Medical Sciences (RIMS)
- Lamphel, Imphal, Manipur, India
- Laxmi Maru
- Professor and Head of Department
- Hospital and MGM Medical College
- Leeza Nazia Hussain
- Senior Resident
- Guwahati Medical College
- Guwahati, Assam, India
- Madhu Nagpal
- Professor and Head
- SGRD IMS and R, Amritsar, Punjab, India
- MK Saha
- Senior Gynecologist
- GB Pant Hospital, Port Blair
- Andaman and Nicobar, India
- Nabakishore singh
- Professor
- Obstetrics and Gynecology
- Regional Institute of Medical Sciences (RIMS)
- Lamphel, Imphal, Manipur, India
- PN Nabis
- Retd Professor and Head
- Obstetrics and Gynecology
- SMC Medical College
- Guwahati, Assam, India
- Pranay Phukan
- Associate Professor
- Obstetrics and Gynecology
- Assam Medical College and Hospital
- Dibrugarh, Assam, India
- Puspa Chowdhury
- Chief Consultant Gynecologist
- Maternal and Women's Hospital
- Kathmandu, Nepal
- Reeta Bhuyan
- Assistant Professor
- Obstetrics and Gynecology
- Guwahati Medical College
- Guwahati, Assam, India
- Ritanjali Behera
- Associate Professor
- Obstetrics and Gynecology
- MKCG Medical College
- Berhampur, Orissa, India
- S Majumder
- Associate Professor
- Obstetrics and Gynecology
- Agartala Medical College
- Tripura, India
- Santa Singh
- Dean and Head of Department
- Obstetrics and Gynecology
- NEIGRIHMS, Mawdiangdiang
- Shillong, Meghalaya, India
- Saswati Sanyal Choudhury
- Associate Professor
- Obstetrics and Gynecology
- Guwahati Medical College
- Guwahati, Assam, India
- Shashi Khare
- Professor and Head
- Obstetrics and Gynecology
- Dean
- Government NSCB Medical College, Jabalpur
- Madhya Pradesh, India
“Never doubt that a small group of thoughtful, committed citizens can change the world.
Indeed, it is the only thing that ever has changed the world!!”
Margaret Mead
Why mothers die?
This is perhaps the most important question that haunts me today. Here I reflect on the preventable deaths and I dream that the FOGSIANs will reduce this and help in brining it on par with the western world.
But I also realize that it is not good enough only to dream – We have to have a plan in place AND we need to plan our work and work our plan.
Here is where we need to work with a firm belief and conviction that—
“We Can Make a Difference”—
as individuals, as team leaders, institutional heads, organizational capacity and influencing the government policy and help them implement it!
I swell with pride when I look at the wonderful work by Dr Dilip Kumar Dutta and his team of committed practitioners, giving the best of all, the outreach and community programs attempting to do their best and I think to myself …. Wow !so much has been done !!
Let us believe “WE” can take the responsibility and let's believe each one of us can make a difference ! That's the first positive step as a THOUGHT…. And then…. Translate it into ACTION !
Congratulations to Dr Dilip Kumar Dutta and his team for this great initiative—a long journey has to begin with one small step—and that significant step has been taken at the first National Congress at Kalyani, titled “WHY MOTHERS DIE?”
Dr Dutta is also publishing and releasing book Insight Maternal Mortality-An Indian Facebook during AICOG conference at Varanasi, UP, India 2012.
It will be this team which will pilot and role model the projects which would lead the action in the rest of India.
I sign off with the thoughts that we are now ready for action and believe that
“If we keep talking about yesterday all the time—we will never have a better tomorrow …..”
Hema Divakar
Hon Secretary of ICOG
11PREFACE
Mr SB lost his wife due to eclampsia at the age of 19 years leaving behind one child. Mr SA, 30 years, lost his wife who had h/o home delivery died spontaneously without any professional help. Mr SR, 27 years, lost his wife at the age of 18 years due to sepsis caused by illegal abortion. Mrs AR, 20 years, delivered a baby at road-side on way to hospital died due to retained placenta.
All these preventable unwanted catastrophes and mourning of their families echo in my heart for the last 30 years. “Why Mothers Die”? Whether it is due to delay to seeking treatment or delay to reach the hospital or delay on the part of the doctor to start treatment or lack of transportation due to bad road condition.
During my tenure (5 years) as Chairman of motherhood committee and Vice-President, FOGSI, I have visited most of the parts of rural area of India. While visiting the rural area, I was so much depressed to see the pathetic situation of some of the pregnant women because of lack of commitment by some of the obstetricians, nursing staff, health providers or due to lack of the eco-socio political commitment.
Women are dying during their long journey of 280 days during pregnancy period without antenatal check up, investigation and treatment. Every minute of everyday a woman dies as a result of pregnancy or child birth somewhere in the world may be due to - (a) Teenage pregnancy, physically not fit to deliver the baby leading to obstructed labor, sepsis, eclampsia and anemia, etc.,(b) Due to want of blood or drug, (c) Elderly women from low socioeconomic resources going for illegal abortion.
Such tragic picture is still existing in many states of India excluding Kerala, Mizoram and in other two or three states. Maternal death reviews are not done in many states till date. No CME on MMR in many places. Government (State and Central) in good faith started National Rural Health Mission (NRHM) by spending a lot of fund but no positive result to prevent MMR so far.
Idea to publish this book is to highlight the different causes of high MMR. While traveling many states of India, I tried to find out the Obstetricians who were really interested to work on MMR. Accordingly, I selected the doctors from different states of India who were experienced to prevent MMR to write the chapter on MMR from their state in this book.
This book has not only highlighted the different causes of MMR and confidential enquiry report of maternal death due to eclampsia and PPH, but also put forward various suggestions made by various experts to prevent MMR.
My whole hearted thanks to Dr Amitave Paul, Dr Kishor Biswas, Dr Indranil Dutta, Dr Banani Dutta (WB), Dr Pranay Phukan, Dr Swati Jain, Dr Ashish, Dr Saswati Sanyal Choudhury, Prof Chanakya Das, Prof PN Nabis, Dr Reeta Bhuyan (Assam), Khumanthem Pratima Devi, Dr Nabakishore Singh, 12Chanam Manglem Singh, Dr L Ranjit Singh (Manipur), Dr Banashree Das (Delhi), Dr S Panda, Dr Santa Sing (Meghalaya), Dr Puspa Chowdhury (Nepal), TK Rajalakshmi, Dr MK Saha, Dr Indu Chawla, Dr Anis Akhtarkhavari (Andaman and Nicobar), Dr Laxmi Maru, Dr Gita Guin, Dr Bharti Sahu, Dr Shashi Khare (Madhya Pradesh), DR Madhu Nagpal and her team (Punjub) and many more who are contributing different chapters in this book.
My sincere thanks to FOGSI that has allowed me to publish this book and also heartful thanks to Jaypee Brothers Medical Publishers to publish this book.
Lastly my deep sense of gratitude to my wife Dr Banani Dutta (DCH, FICMCH), my son Dr Indranil Dutta (MD PGT) and daughter Miss Ipsita Dutta for their active support to publish this book.
Dilip Kumar Dutta