CHENNAI: Tamil Nadu’s mentoring concept in which obstetricians and gynaecologists (OGs) were roped in for management of antenatal mothers was selected by the National Health Mission (NHM) as one of the best practices. Through this initiative, over 2.8 lakh high risk pregnant women were identified during the COVID-19 pandemic in the State.

The mentoring concept – Management of High Risk Antenatal (AN) Mothers during COVID-19 pandemic – introduced by NHM, Tamil Nadu was presented at the 7th National Summit on Good Replicable Practices and Innovations in Public Health Care Systems in India recently.

Launched during November – December 2019, health officials said the concept helped during the pandemic. Officials highlighted the rationale behind the concept as the pandemic and subsequent lockdown measures placed unprecedented demands on the health system especially among pregnant women. Innovative measures to manage the situation was quintessential for delivering quality AN care.

Heads of the department of obstetrics and gynaecology in government medical college hospitals/district headquarters hospitals were designated as chief district obstetrician. Each OG mentored a block covering both low and high risk antenatal women, with all 385 blocks having one mentor OG each.

Under this, a line list of all AN mothers were obtained from Pregnancy and Infant Cohort Monitoring and Evaluation (PICME) and categorised as low risk, moderate risk and high risk antenatal care women. District-wise line list of 7.29 lakh mothers with Expected Date of Delivery (EDD) for the period March 24 to December 31, 2020 was obtained from PICME software and shared to districts/Chief District Obstetrician for ready reference. Microplan was worked out at all levels for tracking of the women.

This was the outcome : a total of 2,81,966 women with high risk factors were identified out of the EDD and followed up. Of this, 1,49,442 delivered normally and 1,32,525 delivered through caesarean section.

“The initiative included both direct mentoring at the district-level and virtual mentoring by linking to medical college hospitals. The mentoring concept was unique and highly appreciated. We had a safe delivery checklist, and the outcome was quite good. Of the nearly 2.8 lakh high risk mothers identified, nearly 50% delivered normally,” Health Secretary J. Radhakrishnan said.

“We had roped in obstetricians and gynaecologists of the district – those working at Comprehensive Emergency, Obstetric and Newborn Care (CEmONC) centres – to mentor one block that is the block primary health centre and its village health nurses (VHN) on antenatal mother management,” said K. Senthil Raj, who was previously the mission director of NHM-Tamil Nadu and now Collector of Thoothukudi.

The VHNs shared the health parameters of the women with the OGs. As a real-time mentoring, they randomly inspected an antenatal clinic in a block every month to see how the primary health centre doctors and VHNs treated antenatal women. This enabled VHNs to directly inform the OGs about high risk women on WhatsApp groups, he added.

“This concept enabled us to provide proper interventional services at the right time to ensure safe delivery. We picked up high risk mothers early enabling admission 10 days before EDD. This will help in further reduction of both maternal and infant mortality which was one of the main objectives. It will also help in bridging the disconnect that existed between the field and institutional care for high risk pregnant women,” he said

As on December 31, 6,460 mothers were positive for COVID-19. “We held a number of mock drills such as how to transport pregnant women, how to handle mothers in COVID-19 wards. As several doctors were under quarantine during the pandemic, we rationalised OG post graduate students and diverted them to centres,” another official said.