Pyramidal referrals additionally contributed, as many women have been initially referred to hospitals the place their condition couldn’t be successfully managed. While generic quality enchancment measures, particularly coaching and monitoring for rigorous software of medical protocols will assist enhance the scenario, the districts and hospitals must develop capability to assess their native situation. Unless native organisational factors, employees information and skill, blood and blood product availability, and local causes for delays in providing care are recognized, it may not be possible to successfully scale back the adverse pregnancy outcomes. An important limitation was we did not have access to the medical records on the frontline hospitals. Organisational and personnel elements, at both main care and in the hospitals, now contribute to nearly all maternal deaths in Indonesia.
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Therefore, we invite you to submit a revised version of the manuscript that addresses the factors raised in the course of the evaluation course of. Recommendations to handle the factors contributing to maternal mortality. For instance, there was an absence of recognition of the seriousness of a case of uncontrolled hypertension, with no plan or urgency concerning the situation.