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Revised Annexure-1 CONFIDENTIAL Facility Based Maternal Death Review Form (To be conducted and filled by Medical Officer on duty and Facility Nodal officer) NOTE: 1. This FB MDR Form must be completed
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How to fill out facility based maternal death

How to fill out facility based maternal death?
01
Start by gathering all relevant information about the maternal death, such as the date and time of occurrence, the location of the facility, and the details of the mother's medical history.
02
Fill out the identification section of the form, including the mother's name, age, and contact information. Also include the name of the facility and the healthcare providers involved in the case.
03
Provide a detailed description of the events leading up to the maternal death, including any complications or underlying medical conditions. Include information about the medical interventions and treatments provided to the mother.
04
Document any relevant laboratory tests, diagnostic procedures, and medications administered during the course of the maternal care.
05
Include information about any consultations or referrals made to other healthcare professionals or specialists during the course of the mother's treatment.
06
Provide detailed information about the immediate cause of maternal death, as well as any contributing factors or underlying causes that may have led to the fatal outcome.
07
If available, include information about the autopsy or postmortem examination conducted on the mother's body, as well as any findings or conclusions from the examination.
08
Finally, sign and date the form, ensuring that all information provided is accurate and complete.
Who needs facility based maternal death?
01
Healthcare providers: Facility-based maternal death reports are essential for healthcare providers involved in the care of pregnant women. It helps them understand the causes of maternal deaths, identify areas for improvement in the healthcare system, and implement strategies to prevent future deaths.
02
Researchers and policymakers: Facility-based maternal death data is crucial for researchers and policymakers to analyze trends, identify disparities, and develop evidence-based interventions and policies to improve maternal health outcomes.
03
Government agencies: Facility-based maternal death reports are necessary for government agencies responsible for monitoring maternal health indicators, evaluating healthcare programs, and allocating resources appropriately.
04
Public health organizations and NGOs: Facility-based maternal death data is valuable for public health organizations and non-governmental organizations working to improve maternal health by providing them with insights into the causes and factors contributing to maternal deaths.
05
Maternal health advocates and activists: Facility-based maternal death reports are important for advocates and activists working to raise awareness about maternal health issues, advocate for policy changes, and generate public support for initiatives that aim to reduce maternal mortality rates.
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What is facility based maternal death?
Facility based maternal death refers to the death of a woman that occurs during pregnancy, childbirth, or within 42 days after the end of pregnancy, while under the care of a health facility.
Who is required to file facility based maternal death?
Healthcare providers, hospitals, clinics, and other healthcare facilities are required to file facility based maternal death.
How to fill out facility based maternal death?
Facility based maternal death should be filled out using a standardized reporting form provided by the health department, including details of the deceased woman's medical history, pregnancy, and the circumstances of her death.
What is the purpose of facility based maternal death?
The purpose of facility based maternal death reporting is to monitor and analyze maternal mortality rates, identify areas for improvement in maternal healthcare, and ultimately, reduce maternal deaths.
What information must be reported on facility based maternal death?
Information such as the woman's age, gestational age, medical conditions, cause of death, healthcare interventions provided, and any contributing factors must be reported on facility based maternal death.
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