The knowledge assessment and reducing the errors of medical certificate of cause of death with sensitization training of physicians: A quality improvement intervention study.

BACKGROUND: A Medical Certificate of Cause of Death (MCCD) is a vital document issued by a doctor and has a prescribed format published by the World Health Organization. It is an essential tool to obtain scientific and reliable information in terms of the cause of mortality. The aim of this study is to assess the knowledge about MCCD and to evaluate the impact of sensitization training on the MCCD among the physicians working in the trauma and emergency department in a Tertiary Care Centre. MATERIALS AND METHODS: A quasi-experimental quality improvement hospital-based study executed in Trauma and Emergency Department of Tertiary Care Hospital in Chhattisgarh State, India. The physicians posted in the Trauma and Emergency Department were participated in the study and attended the sensitization training session on MCCD. Statistical analysis used; the data were entered in Microsoft Excel and analyzed with SPSS version 20 statistical software. Mean scores and standard deviation (SD) were used for pre and posttest data while statistical significance was tested using the paired t-test. P < 0.05 was considered as significant. The technical and medical errors in MCCD forms were depicted in percentages. RESULTS: A total of 54 physicians completed the study, including 42 junior resident doctors, 6 senior resident doctors, and 6 faculties. There was a significant difference in the scores before (M = 4.39, SD = 1.571) and after (M = 7.5, SD = 0.885) the training (t = 17.6, P < 0.0001). The participants showed substantial improvement by reduction in technical errors from 28% to 14% while the medical error also slashed down from 42% to 16%. CONCLUSIONS: Sensitization and educational training should be carried out consistently on regular intervals to improve the knowledge of physicians regarding the appropriate filling of MCCD and minimize the errors in MCCD, ultimately this will enhance usability and comparability of mortality statistics generated from International Classification of Diseases data.

Uterine scar rupture at the site of the placenta accreta presenting as a case of sudden death.

Uterine rupture during pregnancy is a known complication of placenta accreta. This paper presents a case of sudden maternal death in the 27th week of gestation due to a ruptured uterine scar at the site of placenta accreta with a short inter-pregnancy period of 6 months with previous two C-sections. Autopsy findings revealed a massive hemoperitoneum and a thinned out anterolateral uterine wall. Internal examination revealed clotted and fluid blood in the peritoneal cavity with rupture of the anterior uterine wall at the site of the placenta accreta in a healed cesarean section scar. Placenta accreta is a rare complication of pregnancy. However, it is becoming more frequent and a significant risk factor with the increasing rate of C-section.

Uterine scar rupture at the site of the placenta accreta presenting as a case of sudden death

Uterine rupture during pregnancy is a known complication of placenta accreta. This paper presents a case of sudden maternal death in the 27th week of gestation due to a ruptured uterine scar at the site of placenta accreta with a short inter-pregnancy period of 6 months with previous two C-sections. Autopsy findings revealed a massive hemoperitoneum and a thinned out anterolateral uterine wall. Internal examination revealed clotted and fluid blood in the peritoneal cavity with rupture of the anterior uterine wall at the site of the placenta accreta in a healed cesarean section scar. Placenta accreta is a rare complication of pregnancy. However, it is becoming more frequent and a significant risk factor with the increasing rate of C-section.