Maternal death audit is becoming a routine process in the practice of obstetric care in both developed and developing countries. Review of case records of maternal deaths between September 1999 and December 2004 was done to find out the profile of the patients and factors associated with the deaths in a periurban hospital in Dhaka. A total 40 maternal deaths occured among 14,137 live births amounting MMR 282 per 100,000 live births. Mean age of deceased mothers was 24.85± 5.6 years, 25% were primipara and vaginal delivery occurred in 42.46% cases. Thirty percent deaths occured within six hours of admission to hospital and 73% deaths occurred during post-partum period. The primary obstetric cause of deaths were severe pre-eclampsia and eclampsia (42.5%), haemorrhage (17.5%), obstructed labour (12.5%) and sepsis (7.5%) respectively. Facility based audit into maternal deaths provide an opportunity to understand the inciting factors and is recommended to be implemented for improvement of professional practice and management. (J Bangladesh Coll Phys Surg 2006; 24: 5-9)

Objective(S):This study was conducted to evaluate the efficacy and safety of carbetocin in comparison to oxytocin in the active management of third stage of labour following vaginal delivery.Methods:A randomized-controlled trial was conducted in the Institute of Child and Mother Health (ICMH), Dhaka, Bangladesh over a period of nine months from January to September, 2015. Patients who got admitted in ICMH with labour pain were assessed by general examination, abdominal examination and labour status was confirmed by per vaginal examination. On the basis of selection criteria total 94 pregnant women who had undergone vaginal delivery were randomized for two groups of drugs. According to computer generated randomization sequential number was allocated for cases. One group of patients received intravenous 100 micro gram carbetocin and another group of patients received intramuscular 10 IU oxytocin in third stage of labour. Outcome measures such as amount of blood loss in 24 hours, primary PPH, massive blood loss, need of fundal massage, need for additional uterotonic therapy, blood transfusions as well as other adverse effects were all documented.Results: In this study, massive blood loss did not occur in any of patients in carbetocin group. But massive blood loss occurred in 8.5% women of oxytocin group. Further fundal massage, immediate blood transfusion and additional uterotonics were not needed by any patient in carbetocin group. In oxytocin group, fundal massage required in 10.6% of women, blood transfusion was needed for 6.4% patients and additional uterotonics was needed for 10.6% women. Average amount of blood loss were 64 ml less in carbetocin group and adverse effects of drugs were almost similar in both groups. Primary PPH was developed 6.4% in oxytocin group but none of patients developed PPH in carbetocin group.Conclusion: Carbetocin appears to be an effective new drug in the active management of third stage of labour in vaginal delivery. A single dose of 100 microgram IV carbetocin is more effective than oxytocin for maintaining adequate uterine tone, less blood loss and preventing postpartum bleeding in women undergoing vaginal delivery. So, carbetocin can be considered as a good alternative to oxytocin in the active management of third stage of labour in vaginal deliveryBangladesh J Obstet Gynaecol, 2015; Vol. 30(1) : 3-9

Summary:In Bangladesh majority of deliveries are attended by unskilled traditional birth attendants and maternal mortality is still quite high. Global evidence suggests that most critical intervention for reduction of maternal mortality is to ensure skilled attendance at birth.The objective of this study was to explore the effect of strengthening obstetric care services through implementation of skilled Midwives at selected urban centres in terms of utilization of antenatal and delivery care in the community. A total of 6077 mothers having less than one year child were interviewed. There was significant improvement from baseline in the utilization of antenatal care services (6.1 vs. 2.1%, p<0.001), availing antenatal visits 5 times or more (13.4% vs. 8.1%, p<0.001), consultation with skilled health care providers for pregnancy complication (9.3% vs. 5.7 %, p<0.001), institutional delivery (7.3% vs. 4.1%, p<0.001) and delivery by skilled birth attendant (9.4% vs. 5.8%, p<0.001) between intervention and control area respectively. A quasi experimental community trial was conducted duringThe intervention of deployment of skilled midwives improved utilization of ANC, increased institutional delivery and delivery by skilled birth attendants. The program can be scaled up to see its impact on maternal health.

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