Maternal mortality audit — DTM&H MCQ

Correct answer: C — Confidential maternal death review

The correct answer is C, Confidential maternal death review. This is the core public health tool for maternal mortality surveillance because it uses a systematic, multidisciplinary, no-blame audit of care to identify avoidable systemic and clinical factors (delays in recognition, transfusion access, escalation failures) that contributed to death, then feeds findings back into practice change. In the UK, this model is embodied by MBRRACE-UK, whose confidential enquiries explicitly review care to find lessons rather than to apportion individual blame. For a district hospital facing rising postpartum haemorrhage deaths, this structured, protected review process is the mechanism that converts individual tragedies into system-level learning and guideline change, which directly matches the stem's requirement to identify avoidable factors without blaming staff. Why the other options are wrong: E. Routine malaria microscopy: this addresses a different differential (anaemia or fever contributing to haemorrhage risk in endemic settings) but does not create a mechanism for reviewing why deaths from PPH are occurring or how care could be improved. D. Punitive disciplinary panel: this is blame-focused, directly contradicting the stem's explicit requirement for a no-blame system, and evidence shows punitive approaches suppress honest reporting and reduce learning. A. Anonymous media reporting: this externalises the issue for public awareness but has no structured clinical audit methodology, no multidisciplinary expert review, and no defined pathway back into local practice change. B. Newborn hearing screening: this is a neonatal screening programme entirely unrelated to maternal mortality or haemorrhage causation. Key point: Confidential, multidisciplinary, no-blame death review (the MBRRACE-UK model) is the recognised public health standard for converting maternal deaths into actionable, systemic quality improvement.

Reference: MBRRACE-UK, Maternal Confidential Enquiries, National Perinatal Epidemiology Unit, University of Oxford, 2024/2025: https://www.npeu.ox.ac.uk/mbrrace-uk/maternal-programme/maternal-confidential-enquiries