Comprehensive post-loss follow-up to identify maternal morbidities and improve quality of care: A case report from a maternal and child health call-in center in Bangladesh

Background Following perinatal death in low- and middle-income countries, maternal contact with health systems often terminates abruptly, leaving potential pregnancy-related morbidities undetected and untreated. In Bangladesh, where an estimated 48% of women lack postpartum follow-up, critical maternal conditions may remain hidden until subsequent pregnancies, or may never be identified at all. The Bangladesh site of the Child Health and Mortality Prevention Surveillance (CHAMPS) network routinely follows up with mothers following perinatal death through a physician-operated call-in center. We present a case demonstrating how this comprehensive follow-up identified unrecognized maternal morbidity, facilitated clinical re-engagement, and improved the quality of clinical care, resulting in successful illness resolution and a subsequent healthy delivery. Case presentation A 25-year-old woman was admitted to Faridpur Medical College Hospital due to prolonged obstructed labor in her first pregnancy. Subsequently, a stillborn female infant was delivered via an emergency cesarean section. Following informed consent, Minimally Invasive Tissue Sampling (MITS) of the stillborn child was conducted and an expert panel identified the cause of stillbirth was intrauterine hypoxia due to obstructed labor. Three months post-delivery, during a scheduled follow-up call from the CHAMPS call-in center, the mother reported continuous urinary incontinence. Suspecting vesicovaginal fistula (VVF), the call-in center physician facilitated an urgent referral, which led to the confirmation of a 2 cm VVF. The patient conceived seven months post-loss while on the surgical waitlist for repairing the VVF. The CHAMPS team coordinated her antenatal care and informed her high-risk status to hospital obstetricians. She underwent a planned cesarean section at 37 weeks, delivering a healthy male infant. Six weeks later, she underwent successful surgical repair of the VVF. Conclusions This case, representative of successful interventions within CHAMPS Bangladesh, demonstrates how a mortality surveillance system with systematic post-loss follow-up protocols can identify hidden morbidities, improve the quality of clinical care, and mitigate delays in seeking treatment. In settings where primary healthcare access is inconsistent, this model can function as a vital safety net, linking vulnerable populations to clinical care and preventing recurrent adverse outcomes.