
Maternal and Perinatal Death Surveillance Review FY Data
"Review maternal and perinatal deaths, committee members, hospital data, and causes of maternal mortality. Identify modifiable factors to improve outcomes. Track action plans and system approvals for better response. Promote maternal and perinatal health outcomes through data-driven strategies."
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Maternal and Perinatal Death Maternal and Perinatal Death Surveillance and Response (MPDSR) Surveillance and Response (MPDSR) Review Review FY FY / . / . Name of Hospital: _______________________________________ District: __________________________________________ Date of review: DD / MM / YYYY
MPDSR Committee Members MPDSR Committee Members S.N Name of Committee members Designation / post Facility
Hospital Data Hospital Data FY . / . 1. Total deliveries 2. Total live births 3. Total Maternal Deaths 4. Total Stillbirths 4a. Total fresh stillbirths 4b. Total macerated stillbirths 5. Total Early Neonatal Deaths (ENND) 6. Total Perinatal deaths (4 + 5)
Maternal Death Review Maternal Death Review FY . / .. Number of Maternal deaths Number of MDR Forms filled Number of Maternal deaths reviewed by MPDSR committee Number of Action Plans developed after maternal death review Number of Action Plans implemented after maternal death review Number of MDR forms approved in the web- based system
Perinatal Death Review Perinatal Death Review FY / Number of Perinatal deaths Number of PDR Forms filled Number of PDR Summary forms filled Number of Monthly Perinatal death review meeting conducted by MPDSR committee Number of Action Plans developed after monthly perinatal death review Number of Action Plans implemented Number of PDR Summary forms approved in the web- based system
Cause of maternal deaths Cause of maternal deaths S.N Cause Number
Modifiable factors identified Modifiable factors identified Maternal Deaths (3 Delays) (3 Delays) Delay 1 Delay in deciding to / seek care facility Maternal Deaths Delay 2 Delay 3 Delay in reaching health Delay in receiving appropriate care at health facility
Cause of perinatal deaths Cause of perinatal deaths S.N Cause Number
Modifiable factors identified Modifiable factors identified- - Perinatal deaths (3 Delays) (3 Delays) Delay 1 Delay in deciding to / seek care facility Perinatal deaths Delay 2 Delay 3 Delay in reaching health Delay in receiving appropriate care at health facility
Action plans developed Action plans developed S.N Action plans To be completed by (Timeline) Status DD / MM / YYYY DD / MM / YYYY DD / MM / YYYY DD / MM / YYYY DD / MM / YYYY DD / MM / YYYY DD / MM / YYYY DD / MM / YYYY DD / MM / YYYY
Activities conducted Activities conducted
Issues and challenges Issues and challenges
Lessons learned Lessons learned
Gaps Identified Gaps Identified
Recommendations Recommendations