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Background: Hypertensive disorders of pregnancy (HDP) are a major cause of maternal morbidity and mortality, and their association with increased cardiovascular disease (CVD) risk represents a major public health concern. However, assessing CVD risk in women with a history of these conditions presents unique challenges, especially when studies are carried out using routinely collected data. Objectives: To summarise and describe key challenges related to the design and conduct of administrative studies assessing CVD risk in women with a history of HDP and provide concrete recommendations for addressing them in future research. Methods: This is a methodological guidance paper. Results: Several conceptual and methodological factors related to the data‐generating mechanism and study conceptualisation, design/data management and analysis, as well as the interpretation and reporting of study findings should be considered and addressed when designing and carrying out administrative studies on this topic. Researchers should develop an a priori conceptual framework within which the research question is articulated, important study variables are identified and their interrelationships are carefully considered. Conclusions: To advance our understanding of CVD risk in women with a history of HDP, future studies should carefully consider and address the conceptual and methodological considerations outlined in this guidance paper. In highlighting these challenges, and providing specific recommendations for how to address them, our goal is to improve the quality of research carried out on this topic. [ABSTRACT FROM AUTHOR]

This article offers four key lessons learned from a set of seven studies undertaken as part of the collection entitled, "Improving Maternal Health Measurement to Support Efforts toward Ending Preventable Maternal Mortality". These papers were aimed at validating ten of the Ending Preventable Maternal Mortality initiative indicators that capture information on distal causes of maternal mortality. These ten indicators were selected through an inclusive consultative process, and the research designs adhere to global recommendations on conducting indicator validation studies. The findings of these papers are timely and relevant given growing recognition of the role of macro-level social, political, and economic factors in maternal and newborn survival. The four key lessons include: 1) Strengthen efforts to capture maternal and newborn health policies to enable global progress assessments while reducing multiple requests to countries for similar data; 2) Monitor indicator "bundles" to understand degree of policy implementation, inconsistencies between laws and practices, and responsiveness of policies to individual and community needs; 3) Promote regular monitoring of a holistic set of human resource metrics to understand how to effectively strengthen the maternal and newborn health workforce; and 4) Develop and disseminate clear guidance for countries on how to assess health system as well as broader social and political determinants of maternal and newborn health. These lessons are consistent with the Kirkland principles of focus, relevance, innovation, equity, global leadership, and country ownership. They stress the value of indicator sets to understand complex phenomenon related to maternal and newborn health, including small groupings of complementary indicators for measuring policy implementation and health workforce issues. They also stress the fundamental ethos that maternal and newborn health indicators should only be tracked if they can drive actions at global, regional, national, or sub-national levels that improve lives. [ABSTRACT FROM AUTHOR]

Background: Most countries are off-track to achieve global maternal and newborn health goals. Global stakeholders agree that investment in midwifery is an important element of the solution. During a global shortage of health workers, strategic decisions must be made about how to configure services to achieve the best possible outcomes with the available resources. This paper aims to assess the relationship between the strength of low- and middle-income countries' (LMICs') midwifery profession and key maternal and newborn health outcomes, and thus to prompt policy dialogue about service configuration. Methods: Using the most recent available data from publicly available global databases for the period 2000–2020, we conducted an ecological study to examine the association between the number of midwives per 10,000 population and: (i) maternal mortality, (ii) neonatal mortality, and (iii) caesarean birth rate in LMICs. We developed a composite measure of the strength of the midwifery profession, and examined its relationship with maternal mortality. Results: In LMICs (especially low-income countries), higher availability of midwives is associated with lower maternal and neonatal mortality. In upper-middle-income countries, higher availability of midwives is associated with caesarean birth rates close to 10–15%. However, some countries achieved good outcomes without increasing midwife availability, and some have increased midwife availability and not achieved good outcomes. Similarly, while stronger midwifery service structures are associated with greater reductions in maternal mortality, this is not true in every country. Conclusions: A complex web of health system factors and social determinants contribute to maternal and newborn health outcomes, but there is enough evidence from this and other studies to indicate that midwives can be a highly cost-effective element of national strategies to improve these outcomes. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusions Mothers and infants continue to die at alarming rates throughout the Global South. Evidence suggests that high‐quality midwifery care significantly reduces preventable maternal and neonatal morbidity and mortality. This paper uses a case study approach to describe the social and institutional model at one birth center in Northern Uganda where, in over 20,000 births, there have been no maternal deaths and the neonatal mortality rate is 11/1000—a rate that is lower than many high‐resource countries.This case study combined institutional ethnographic and narrative methods to explore key maternal and neonatal outcomes. The sample included birthing people who intended to or had given birth at the center, as well as the midwives, staff, stakeholders, and community health workers affiliated with the center. Data were collected through individual and small group interviews, participant observation, field notes, data and document reviews. Iterative and systematic analytical steps were followed, and all data were organized and managed with Atlas.ti software.Findings describe the setting, an overview of the birth center's history, how it is situated within the community, its staffing, administration, clinical outcomes, and model of care. A synthesis of contextual variables and key outcomes as they relate to the components of the evidence‐informed Quality Maternal and Newborn Care (QMNC) framework are presented. Three overarching themes were identified: (a) community knowledge and understanding, (b) community integrated care, and (c) quality care that is respectful, accessible, and available.This birth center is an example of care that embodies the findings and anticipated outcomes described in the QMNC framework. Replication of this model in other childbearing settings may help alleviate unnecessary perinatal morbidity and mortality. [ABSTRACT FROM AUTHOR]

Adverse maternal and infant health outcomes among African Americans are increasingly recognized as indicators of a critical public health crisis in the United States. Research has found that stress is related to structural racism and the social determinants of health (SDOH) that cause avoidable, unfair inequities in resources, education, power, and opportunities across ethnic groups. This paper describes the SDOH needs and experiences of pregnant Black women from the perspective of doulas and Birthing Beautiful Communities (BBC) clients. The design was a qualitative description, using data collected over time (2017–2018, 2020–2021, and 2023). This study took place in Cleveland and Akron, Ohio and the sample included 58 clients, 26 doulas, and 2 resource intake specialist assistants (RISAs). Qualitative data included individual client interviews, three doula focus groups, and one interview with two BBC RISAs. Three coders used content analysis to deductively identify SDOHs and calculate the number of interviews that contained information about specific SDOHs. Although the sample reported issues with all SDOH, particular ones caused a cascade of SDOH effects. Transportation issues, for example, impeded women from being able to make it to work, doctor's appointments, and to purchase essential baby items (e.g., food, infant supplies). An inability to work—whether because of transportation challenges or pregnancy-related health complications—led to unstable housing and an inability to deal with transportation challenges. Many clients mentioned that housing was a major issue, with many clients experiencing housing instability. Implications include ensuring SDOH information is collected from a trusted source who can advocate and ensure access to a wide range of local resources, ensuring policies protect pregnant women from experiencing a cascade of SDOH that may contribute to continuing health disparate infant and maternal health outcomes in African American women. [ABSTRACT FROM AUTHOR]

This paper presents, from an approach of archaeothanatology, osteobiography, bioarchaeology of care and palimpsest, the analysis of one of the most important archaeological findings recently made in western Mexico. It is about a female person buried in a lavish tomb in the Tingambato archaeological site, Michoacán, Mexico, dated 1400 years ago, with more than 19,000 objects covering her body. This research presents the results of the work of almost a decade of studies carried out by different methods on this individual: morphophysical studies, taphonomy, dating, genetics, as well as various techniques of virtual archaeology among others. Through the Index of Care it was possible to systematize all the information obtained by different study methods and integrate it for analysis. The use of archaeothanatology and the Index of Care makes it possible to perform analyses on specific individuals from the past to establish their health conditions and the probable causes of death. The main limitation that arose was the poor state of preservation in which we received the bones, which unfortunately did not allow us to carry out some morphoscopic and taphonomic studies that would have been relevant. [ABSTRACT FROM AUTHOR]

In about last three decades, many developing countries have experienced a large decline in maternal mortality rates. Global initiatives leading to better maternal health policies may have contributed to this decline. In this paper, we investigate whether maternal health intervention also improves the fetal survival rate. For this purpose, we consider the Village Midwife Program in Indonesia, which was launched in 1989 as a part of the safe motherhood strategy. Using the Indonesian Family Life Survey (IFLS), we investigate the impact of midwives on fetal survival rate in terms of a change in the likelihood of a live birth being male. Our results show that the provision of a midwife in a community increases the probability of a live birth being male by about 3 percentage points. Greater antenatal care, skilled birth-attendance, and an improvement in nutrition among reproductive-age women—in terms of greater BMI—are the likely pathways. We do not find the results to be driven by pre-treatment trends, and they remain robust to a number of checks. [ABSTRACT FROM AUTHOR]

The hydrological patterns of all natural water bodies pulse in variable rhythms of high and low water. The biodiversity of these ecosystems is driven by the changing nature of the environment, allowing different life strategies to coexist, e.g., by the fast reuse of nutrients when aquatic biota flourish in the recently wetted zones and vice versa. Much of the human culture in hydroscapes has developed as an adaptation to this rhythm, e.g., by using the flood‐fertilised floodplains for agriculture or fisheries, or by seasonal migration into or out of the floodplain (transhumance). Technological advances have allowed humans to control, change, or even eliminate this natural water rhythm by building dams, dikes, and canals. Consequently, important ecosystem functions fail, often resulting in failure of human life‐support systems but also in the failure and decline of cultural activities. I argue that the loss of socio‐cultural connectivity to the rhythms of rivers and other hydrosystems occurs in four phases: (i) loss of direct relationships (e.g., uses of waterborne resources), (ii) loss of indirect relationships (cultural activities that are connected to theses uses), (iii) turning away from the river/hydrosystem (often caused by decreased water quality), and (iv) total oblivion (caused by removal or burial of the hydrosystem). Reintegrating more riverine rhythms into human life would not mean to step back in time but rather to find a combination of revised traditional ecological knowledge, learning from nature, changing values in the context of use of natural resources, and innovations. This paper draws on social‐environmental aspects of the River Culture Concept – which attempts to reintegrate respect for the pulsing nature of hydrosystems into modern, sustainable management – and on diverse case studies. Examples are presented on how River Culture Concept approaches may contribute to revitalising socio‐ecological linkages to the rhythm of the waters. [ABSTRACT FROM AUTHOR]

The goal of this article is to recount the birth and development of midwifery and maternal care education in Bulgaria after the Bulgarian Liberation at the end of XIX and the beginning of the XX century. The researchers set the following tasks: 1) to present the main reasons for the emergence of professional midwifery education in post-Liberation Bulgaria; 2) to show the place and role of the first professionally trained midwives in Bulgaria; 3) to outline the seminal work of notable personalities for the development of professional midwifery care. Historical method was used, secondary historical sources, documents and scientific papers were reviewed. Conclusions: Professional midwifery education helped the introduction and spread of modern Obstetrics/Gynecology medicine, which lead to decrease in maternal and infant mortality and slowly improved quality of life for Bulgarian women and children. Bulgarian nationals educated abroad brought to the country the scientific foundation and best practices in maternal health care. [ABSTRACT FROM AUTHOR]

Background: The Three Delays Framework was instrumental in the reduction of maternal mortality leading up to, and during the Millennium Development Goals. However, this paper suggests the original framework might be reconsidered, now that most mothers give birth in facilities, the quality and continuity of the clinical care is of growing importance. Methods: The paper explores the factors that contributed to maternal deaths in rural Pakistan and Mozambique, using 76 verbal autopsy narratives from the Community Level Interventions for Pre-eclampsia (CLIP) Trial. Results: Qualitative analysis of these maternal death narratives in both countries reveals an interplay of various influences, such as, underlying risks and comorbidities, temporary improvements after seeking care, gaps in quality care in emergencies, convoluted referral systems, and arrival at the final facility in critical condition. Evaluation of these narratives helps to reframe the pathways of maternal mortality beyond a single journey of care-seeking, to update the categories of seeking, reaching and receiving care. Conclusions: There is a need to supplement the pioneering "Three Delays Framework" to include focusing on continuity of care and the "Four Critical Connection Points": (1) between the stages of pregnancy, (2) between families and health care workers, (3) between health care facilities and (4) between multiple care-seeking journeys. Trial registration: NCT01911494, Date Registered 30/07/2013. [ABSTRACT FROM AUTHOR]

Preeclampsia, a hypertensive disorder of pregnancy, poses a serious threat to the health of women and infants, causing over 75,000 maternal deaths and more than 500,000 infant deaths annually worldwide. Its grim toll is compounded by adverse maternal complications, such as seizures (eclampsia), liver dysfunction, or pulmonary edema. Although interventions like antihypertensives and magnesium sulfate offer partial mitigation of risks to the mother, the definitive remedy remains delivery of the infant and placenta. However, this solution begets iatrogenic prematurity, ushering infants into a neonatal period fraught with serious complications, such as bronchopulmonary dysplasia and necrotizing enterocolitis, as well as other long-term consequences. In 1914, James Young proposed that interference with uterine blood supply to the placenta would lead to placental infarctions that, in turn, would release toxins into the maternal circulation, thus causing eclampsia (summarized in ref. 1). Decades later, during the mid-1980s, Roberts and Taylor hypothesized that preeclampsia is a endothelial disease based on the observation that the endothelium was the predominant cell type injured during preeclampsia and because endothelial injury antedated the clinical manifestations of disease (2). In a 2003 JCI paper, our group reported evidence and posited that elevated levels of soluble fms-like tyrosine kinase 1 (sFLT1) secreted from the placenta acted as the putative "endothelial toxin" that drives the clinical syndrome of preeclampsia (3). Below, we [ABSTRACT FROM AUTHOR]

Background This paper sheds light on the trends of the maternal mortality ratio (MMR) and obstetric transition in Somalia over the last two decades. Methods This is a descriptive study comparing aggregate secondary data from the 2006 Multiple Indicator Cluster Survey and the 2020 Somali Health and Demographic Survey to show the transition. Results A 44% reduction of the MMR from 1044 to 692 per 100 000 live births was observed comparing the two surveys. Conclusions Somalia has moved from stage I to stage II of the obstetric transition pathway spectrum and there is optimism that the ongoing strengthening of the health system is paying off. [ABSTRACT FROM AUTHOR]

Background: The timely provision of comprehensive contraceptive services to Rohingya women is impeded due to a lack of clarity and understanding of their traditional beliefs and cultural frameworks. Recognizing this challenge, our paper aims to explore the socio-cultural factors influencing the utilization of contraceptives among married Rohingya women living in the refugee camps of Cox's Bazar, Bangladesh. Method: A qualitative study was conducted in two unregistered Rohingya camps (Camp 7&14) located in Ukhiya Upazila, Cox's Bazar from January 10th to 20th, 2022. A total of 14 In-Depth Interviews (IDIs) were conducted among married Rohingya women of reproductive age (15–49 years), along with 16 Key Informant Interviews (KIIs) involving stakeholders engaged in reproductive healthcare provision. Participants were selected using purposive sampling. All interviews were conducted in the local language, recorded, transcribed verbatim, and subsequently translated into English. The data were analyzed using NVivo (Version 11), and the analysis process followed Neuman's three-phase coding system. Results: Five broad themes were identified: Sociocultural expectations and values attached to births, power imbalances within marital relationships, the role of religious beliefs, fear of side effects, and misperceptions about contraception. Having a larger number of children is viewed positively as it is believed that children play a crucial role in preserving the lineage and contributing to the growth of the Islamic population. Despite expressing an inclination towards contraception, the disapproval of husbands becomes a significant barrier for women. Defying their husbands' wishes can result in instances of Intimate Partner Violence (IPV) and even marriage dissolution within the camps. Moreover, the fear of side effects, such as a particular method would cause infertility, discourages women from using contraception. Many of these fears stem from myths, misconceptions, and mistrust in the existing medical system. Conclusion: Addressing the socio-cultural barriers that prevent women from using modern contraception will have important public health implications. These findings can support in crafting culturally sensitive programs and educational interventions. These initiatives can assist Rohingya refugee women in planning their pregnancies and reducing high-risk pregnancies, ultimately leading to a decrease in maternal mortality rates within the community. Plain language summary: The timely provision of comprehensive contraceptive services to Rohingya women is impeded due to a lack of clarity and understanding of their traditional beliefs and cultural frameworks. Taking this into account, our objective is to investigate the socio-cultural factors that influence the utilization of contraceptives among married Rohingya women living in the refugee camps of Cox's Bazar, Bangladesh. A total of 14 IDIs and 16 KIIs were conducted in two unregistered Rohingya camps. We found that contraceptive use among Rohingya refugees was constrained by various socio-cultural and religious beliefs. The desire for a larger number of children to ensure the continuity of the lineage and to be able to contribute to the growth of the Islamic population serves as a major barrier. Lack of decision-making power regarding reproductive life not only stops participation but also makes women vulnerable to IPV and marriage dissolution within the camps. Moreover, the fear of side effects, such as a particular method would cause infertility, discourages women from using contraception. Many of these fears stem from myths, misconceptions, and mistrust in the existing medical system. Young women often acquire information about both true side effects and myths from their social networks. Therefore, developing culturally sensitive programs and educational interventions targeting the women, their peers, and other related communities is indispensable to assist Rohingya refugee women in overcoming the identified barriers to contraception. [ABSTRACT FROM AUTHOR]

Placenta accreta spectrum disorder (PASD) encompasses various types of abnormal placentation in which chorionic villi directly adhere to or invade the myometrium. The incidence of PASD has dramatically risen in the US over the past 3 decades owing to the increased rates of patients undergoing cesarean sections. While PASD remains a significant cause of maternal morbidity and mortality, accurate prenatal identification and characterization of PASD is associated with improved outcomes. Although ultrasound is the first-line imaging modality in the evaluation of PASD, with MRI serving as an adjunct, computed tomography angiography (CTA) may also offer unique diagnostic advantages in cases of advanced PASD by providing superior visualization of placental and abdominopelvic vasculature and enabling the creation of comprehensive vascular maps to roadmap complex surgical interventions. This paper represents the first evaluation of CTA as a diagnostic tool and operative planning aid in this context. Appropriate indications and diagnostic advantages of CTA in this setting are reviewed, and key multimodal imaging features of normal and abnormal placentation are highlighted. [ABSTRACT FROM AUTHOR]

This award has been established for the purpose of encouraging investigators, especially young scientists, from low- and middle-income countries to submit their very best clinical research articles for publication in IJGO. The editors of the I International Journal of Gynecology and Obstetrics i (IJGO) are pleased to announce a prize award for the best clinical research paper from a low- or middle-income country published in the IJGO during 2021. IJGO is the official publication of the International Federation of Gynecology and Obstetrics (FIGO), the primary international organization for the specialty of obstetrics and gynecology. [Extracted from the article]

Objectives: To characterize pregnant women admitted to Irene Neto Maternity Hospital, Lubango city, Huíla province, and their pregnancy outcomes. Methods: We conducted a descriptive cross-sectional facility-based survey between October 2016 and September 2017, involving 500 pregnant women, followed from admission in labor until the end of delivery. Mean (SD) was computed for quantitative variables, while relative and absolute frequencies were determined for categorical variables. Additionally, confidence intervals were estimated. Results: Among pregnant women 18.3% were adolescents (≤ 19 years) and 14.5% had advanced maternal age (≥ 35 years). Illiteracy was reported by 8.2%. One in three (33.6%) had a short stature (< 1.55 m). Malaria was the most frequent infection during pregnancy (16.3%). Upon admission, 18.1% were anemic (Hb < 11 g/dl) and 36.0% had hypertension (SBP ≥ 140 mmHg and/or DBP ≥ 90 mmHg), contrasting with the few cases reported of chronic hypertension and pregnancy-induced hypertension. There were 15 twin pregnancies. Cesarean section was performed in 25.2% of the women, although there was no medical indication for 23.0% of women having cesareans. Two maternal deaths occurred in our sample. Among live births from singleton pregnancies (97.1%), birth asphyxia (Apgar < 7 at 5 min) was observed in 22.7% and 10.3% had low birth weight (< 2.5 kg). Conclusions: There are very few studies reporting pregnancy outcomes in Angola. This analysis presents data from Huíla province, the second most populous province. We identified characteristics for higher risk of adverse pregnancy outcomes: adolescence, illiteracy, and short stature. Among newborn outcomes, birth asphyxia and low birth weight demand special attention. Further research is needed to explore the non-medical indications for cesarean section and to better understand the twinning rate in Lubango. Significance: The significance of this paper is that it is one of the very few reports contributing for the knowledge of detailed maternal, obstetric and newborn outcomes in Angolan women. Although our study only addresses the outcomes descriptively, it can be used as a first step in monitoring and improving outcomes of Angolan women. Maternal and child health is a key issue to address sustainable development in Angola. [ABSTRACT FROM AUTHOR]

Global maternal and neonatal mortality rates remain unacceptably high. The postnatal period, encompassing the first hour of life until 42 days, is critical for mother-baby dyads, yet postnatal care (PNC) coverage is low. Identifying mother-baby dyads at increased risk for adverse outcomes is critical. Yet few efforts have synthesized research on proximate and distant factors associated with maternal and neonatal mortality during the postnatal period. This scoping review identified proximate and distant factors associated with maternal and neonatal mortality during the postnatal period within low- and middle-income countries (LMICs). A rigorous, systematic search of four electronic databases was undertaken to identify studies published within the last 11 years containing data on risk factors among nationally representative samples. Results were synthesized narratively. Seventy-nine studies were included. Five papers examined maternal mortality, one focused on maternal and neonatal mortality, and the rest focused on neonatal mortality. Regarding proximate factors, maternal age, parity, birth interval, birth order/rank, neonate sex, birth weight, multiple-gestation, previous history of child death, and lack of or inadequate antenatal care visits were associated with increased neonatal mortality risk. Distant factors for neonatal mortality included low levels of parental education, parental employment, rural residence, low household income, solid fuel use, and lack of clean water. This review identified risk factors that could be applied to identify mother-baby dyads with increased mortality risk for targeted PNC. Given risks inherent in pregnancy and childbirth, adverse outcomes can occur among dyads without obvious risk factors; providing timely PNC to all is critical. Efforts to reduce the prevalence of risk factors could improve maternal and newborn outcomes. Few studies exploring maternal mortality risk factors were available; investments in population-based studies to identify factors associated with maternal mortality are needed. Harmonizing categorization of factors (e.g., age, education) is a gap for future research. [ABSTRACT FROM AUTHOR]

Many studies have demonstrated the significant involvement of Traditional Birth Attendants (TBAs) during pregnancy and delivery. In several countries, including Indonesia, the role of the TBA cannot be easily replaced by Skilled Birth Attendants (SBAs), reducing the capacity of the health sector to reduce the maternal mortality rate. The TBA has a religious and social connection with the community in her area which is often undervalued by the medically-trained SBA; this disconnect interferes with the provision of quality care. In this paper, with the use of a narrative approach, a TBA reveals her reflection and perspective as rooted in the community where she lives. This ethnography provides living evidence that the point of view of modern health professionals often fails when faced with the world view of the community. TBAs have social power that cannot be separated from the social context where they live. Therefore, an analysis of the religious aspects of a TBA's practice should enrich the effort to decrease the maternal mortality rate. The religiosity of a community is closely connected with the community's perspective on health. [ABSTRACT FROM AUTHOR]

Key Clinical Message: This paper highlights that diagnosis and treatment of one ectopic pregnancy does not rule out the happening of a second ectopic pregnancy in the same patient concurrently, especially if the patient has rising β‐hCG and persistent symptoms. Bilateral tubal pregnancy (BTP) is the most uncommon form of tubal ectopic pregnancy. Complications can lead to maternal morbidity and mortality. We reported a case of left tubal pregnancy and the patient underwent laparoscopic salpingostomy. During the follow‐up, the contralateral ectopic pregnancy was discovered and treated with MTX. [ABSTRACT FROM AUTHOR]

Background: Responsive and resilient strategies to reduce high rates of maternal and infant mortality and clinician shortages are needed in low- and middle-income countries (LMICs). Malawi has some of the highest maternal and infant mortality rates globally. Group healthcare is a service delivery model that integrates these strategies. Although primarily implemented during the prenatal period, its potential for improving both maternal and infant health outcomes during the postpartum period has not been realized. The purpose of this study was to adapt and co-design the prototype for an evidence-based group care model for the postpartum period using a human-centered design approach with key stakeholders in Malawi. Methods: We completed steps of a framework guiding the use of human-centered design: 1) define the problem and assemble a team; 2) gather information through evidence and inspiration; 3) synthesize; and 4) intervention design: guiding principles and ideation. Qualitative methods were used to complete steps 2–4. In-depth interviews (n = 24), and incubator sessions (n = 6) that employed free listing, pile sorting and ranking were completed with key stakeholders. Data analysis consisted of content analysis of interviews and framework analysis for incubator sessions to produce the integrated group postpartum and well-child care model prototype. The fifth step is detailed in a separate paper. Results: All stakeholders reported a desire to participate in and offer group care in the postpartum period. Stakeholders worked collaboratively to co-create the prototype that included a curriculum of health promotion topics and interactive activities and the service delivery structure. Health promotion topic priorities were hygiene, breastfeeding, family planning, nutrition, and mental health. The recommended schedule included 6 sessions corresponding with the child vaccination schedule over the 12-month postpartum period. Conclusions: Using a human-centered design approach to adapt an evidence-based group care model in an LMIC, specifically Malawi, is feasible and acceptable to key stakeholders and resulted in a prototype curriculum and practical strategies for clinic implementation. [ABSTRACT FROM AUTHOR]

Objectives: The World Health Organization has adopted two main strategies to improve the quality of maternal health: increasing the number of deliveries by skilled birth attendants and increasing access to emergency obstetric care. Despite increased access to care, there continue to be high rates of maternal morbidity and mortality in part due to quality of care. This study aims to identify and summarize existing frameworks for measuring quality of maternal care at a facility-level. Methods: PubMed, Health Systems Evidence, Embase, Global Health, OVID Healthstar, OVID Medline, PsycINFO, and Web of Science were searched for frameworks, tools, theories, or components of frameworks relevant to maternal quality of care in facility-level settings. Title/abstract and full-text screening were completed by two independent reviewers and conflicts resolved through consensus or a third reviewer. Results: An initial search resulted in 3182 studies. Fifty-four studies were included in the qualitative analysis. A best fit framework analysis was done using the updated Hulton framework as the conceptual framework. A facility-based maternal quality of care framework is proposed including the following components, separated into provision and experience of care: (1) human resources; (2) infrastructure; (3) equipment, supplies and medicine; (4) evidence and information; (5) referral and networks of care; (6) cultural competence; (7) clinical practice; (8) financing; (9) leadership and governance; (10) cognition; and 11) respect, dignity, equity, and emotional support. Significance: Despite increased institutional access to care, there continue to be high rates of maternal morbidity and mortality in some low- and middle-income countries. This is in part due to the quality of maternal care once care has been accessed. Several frameworks have been proposed for understanding the complexities surrounding quality of care in maternal health but there has not been a single framework consistently used in the literature for facility-based quality of maternal care. This paper identifies and summarizes existing frameworks and tools, and uses a best fit framework analysis to propose a comprehensive framework for assessing facility-based maternal quality of care. [ABSTRACT FROM AUTHOR]

Background: This is the final of 10 papers that describe the implementation of the Expanded Census-Based, Impact-Oriented Approach (CBIO+) by Curamericas/Guatemala in the Cuchumatanes mountains of the Department of Huehuetenango and its effectiveness in improving the health and well-being of women and children in a population of 98,000 in three municipalities. The CBIO+ Approach consists of three components: the CBIO (Census-Based, Impact-Oriented) Approach, the Care Group Approach, and the Community Birthing Center Approach. Methods: Each of the preceding papers was summarized. An assessment was made regarding the degree to which the initial implementation research hypotheses were confirmed. The total field cost per capita for operation of the Project was calculated. An assessment of the cost-effectiveness of the Project was made based on the estimated impact of the Project, the number of lives saved, and the number of disability-adjusted life years averted. Results: The Project attained a number of notable achievements in terms of expanding the coverage of key maternal and child health interventions, improving the nutritional status of children, reducing the mortality of children and mothers, providing quality care for mothers at the Community Birthing Centers (Casas Maternas Rurales) that integrate traditional midwives (comadronas) into the care of women during childbirth at the birthing centers, as well as empowering women and building social capital in the communities. CBIO+ is an effective and affordable approach that is particularly notable for its capacity to engage communities in the process of improving the health of mothers and children. Overall, there is strong and consistent evidence in support of the research hypotheses. The findings did produce evidence of declines in under-5 and maternal mortality, but they were not as robust as had been hoped. Conclusion: CBIO+ is an approach that has been effective in engaging communities in the process of improving the health of their mothers and children and in reducing health inequities in this marginalized, difficult-to-reach population of Indigenous Maya people. The CBIO+ Approach is cost-effective and merits further development and broader application in Guatemala and beyond. [ABSTRACT FROM AUTHOR]

Background: In Guatemala, Indigenous women have a maternal mortality ratio over twice that of non-Indigenous women. Long-standing marginalization of Indigenous groups and three decades of civil war have resulted in persistent linguistic, economic, cultural, and physical barriers to maternity care. Curamericas/Guatemala facilitated the development of three community-built, -owned, and -operated birthing centers, Casas Maternas Rurales (referred to here as Community Birthing Centers), where auxiliary nurses provided physically accessible and culturally acceptable clinical care. The objective of this paper is to assess the management of complications and the decision-making pathways of Birthing Center staff for complication management and referral. This is the sixth paper in the series of 10 articles. Birthing centers are part of the Expanded Census-based, Impact-oriented Approach, referred to as CBIO+. Methods: We undertook an explanatory, mixed-methods study on the handling of pregnancy complications at the Birthing Centers, including a chart review of pregnancy complications encountered among 1,378 women coming to a Birthing Center between 2009 and 2016 and inductively coded interviews with Birthing Center staff. Results: During the study period, 1378 women presented to a Birthing Center for delivery-related care. Of the 211 peripartum complications encountered, 42.2% were successfully resolved at a Birthing Center and 57.8% were referred to higher-level care. Only one maternal death occurred, yielding a maternal mortality ratio of 72.6 maternal deaths per 100,000 live births. The qualitative study found that staff attribute their successful management of complications to frequent, high-quality trainings, task-shifting, a network of consultative support, and a collaborative atmosphere. Conclusion: The Birthing Centers were able to resolve almost one-half of the peripartum complications and to promptly refer almost all of the others to a higher level of care, resulting in a maternal mortality ratio less than half that for all Indigenous Guatemalan women. This is the first study we are aware of that analyzes the management of obstetrical complications in such a setting. Barriers to providing high-quality maternity care, including obtaining care for complications, need to be addressed to ensure that all pregnant women in such settings have access to a level of care that is their fundamental human right. [ABSTRACT FROM AUTHOR]

Background: The Curamericas/Guatemala Maternal and Child Health Project, 2011–2015, implemented the Census-Based, Impact-Oriented Approach, the Care Group Approach, and the Community Birthing Center Approach. Together, this expanded set of approaches is known as CBIO+. This is the fifth of 10 papers in our supplement describing the Project and the effectiveness of the CBIO+ Approach. This paper assesses causes, levels, and risk factors for mortality along with changes in mortality. Methods: The Project maintained Vital Events Registers and conducted verbal autopsies for all deaths of women of reproductive age and under-5 children. Mortality rates and causes of death were derived from these data. To increase the robustness of our findings, we also indirectly estimated mortality decline using the Lives Saved Tool (LiST). Findings: The leading causes of maternal and under-5 mortality were postpartum hemorrhage and pneumonia, respectively. Home births were associated with an eight-fold increased risk of both maternal (p = 0.01) and neonatal (p = 0.00) mortality. The analysis of vital events data indicated that maternal mortality declined from 632 deaths per 100,000 live births in Years 1 and 2 to 257 deaths per 100,000 live birth in Years 3 and 4, a decline of 59.1%. The vital events data revealed no observable decline in neonatal or under-5 mortality. However, the 12–59-month mortality rate declined from 9 deaths per 1000 live births in the first three years of the Project to 2 deaths per 1000 live births in the final year. The LiST model estimated a net decline of 12, 5, and 22% for maternal, neonatal and under-5 mortality, respectively. Conclusion: The baseline maternal mortality ratio is one of the highest in the Western hemisphere. There is strong evidence of a decline in maternal mortality in the Project Area. The evidence of a decline in neonatal and under-5 mortality is less robust. Childhood pneumonia and neonatal conditions were the leading causes of under-5 mortality. Expanding access to evidence-based community-based interventions for (1) prevention of postpartum hemorrhage, (2) home-based neonatal care, and (3) management of childhood pneumonia could help further reduce mortality in the Project Area and in similar areas of Guatemala and beyond. [ABSTRACT FROM AUTHOR]

The objective of this paper is to share Nepali experience of maternal death surveillance and response in reducing preventable maternal deaths. Secondary data, mainly an assessment report of Maternal and Perinatal Death Surveillance and Response system, is used in developing this paper. To bridge the information gap, informal discussions were held with key informants. Reducing maternal mortality is an unfinished agenda of millennium development goals, which is carried over to sustainable development goals era. Nepal, building on an ongoing initiative of Maternal Death Review, established a Maternal and Perinatal Death Surveillance and Response system. It comprises: (a) maternal death review and response in community; and (b) maternal death review and response in hospitals. Until 2019, 11 districts implemented the former component, while 77 hospitals practiced the latter. The main reason underlying maternal death was delay in getting adequate care. Social factors contributed to delay in 89.6% of cases, while in 10.4% of cases, it was attributed to factors in health care. The paper concludes that public health measures and improved service quality was key in preventing maternal deaths. It is, however, imperative to undertake an in-depth review and thereby define interventions for strengthening and upscaling the initiative. [ABSTRACT FROM AUTHOR]

Stark disparities persist in maternal mortality and perinatal outcomes for Black and other birthing people of color, such as Native Americans, and their newborns compared to White people in the United States. An increasing body of research describes the phenomenon of implicit racial bias among providers and how it may affect communication, treatment decisions, the patient care experience, and health outcomes. This synthesis of literature reviews and distills current research on the presence and influence of implicit racial bias among nurses as it may relate to maternal and pregnancy‐related care and outcomes. In this paper, we also summarize what is known about implicit racial bias among other types of healthcare providers and interventions that can mitigate its effects, identify a gap in research, and recommend next steps for nurses and nurse researchers. [ABSTRACT FROM AUTHOR]

Background: Despite progress, maternal and neonatal mortality and still births remain high in South Africa. The South African National Department of Health implemented a quality improvement (QI) programme, called Mphatlalatsane, to reduce maternal and neonatal mortality and still births. It was implemented in 21 public health facilities, seven per participating province, between 2018 and 2022. Methods: We conducted a qualitative process evaluation of the contextual and implementation process factors' influence on implementation uptake amongst the QI teams in 15 purposively selected facilities. Data collection included three interview rounds with the leaders and members of the QI teams in each facility; intermittent interviews with the QI advisors; programme documentation review; observation of programme management meetings; and keeping a fieldwork journal. All data were thematically analysed in Atlas.ti. Implementation uptake varied across the three provinces and between facilities within provinces. Results: Between March and August 2020, the COVID-19 pandemic disrupted uptake in all provinces but affected QI teams in one province more severely than others, because they received limited pre-pandemic training. Better uptake among other sites was attributed to receiving more QI training pre-COVID-19, having an experienced QI advisor, and good teamwork. Uptake was more challenging amongst hospital teams which had more staff and more complicated MNH services, versus the primary healthcare facilities. We also attributed better uptake to greater district management support. A key factor shaping uptake was leaders' intrinsic motivation to apply QI methodology. We found that, across sites, organic adaptations to the QI methodology were made by teams, started during COVID-19. Teams did away with rapid testing of change ideas and keeping a paper trail of the steps followed. Though still using data to identify service problems, they used self-developed audit tools to record intervention effectiveness, and not the prescribed tools. Conclusions: Our study underscores the critical role of intrinsic motivation of team leaders, support from experienced technical QI advisors, and context-sensitive adaptations to maximise QI uptake when traditionally recognised QI steps cannot be followed. [ABSTRACT FROM AUTHOR]

A study from the Netherlands published in BJOG: An International Journal of Obstetrics & Gynaecology highlights the increasing percentage of maternal deaths due to suicide. The Netherlands has seen a rise in maternal deaths from suicide, making it the leading cause of maternal death in the country. This issue is not unique to the Netherlands, as suicide is also the most common cause of maternal death in the U.K., France, and the U.S. Improved screening and treatment for mental health conditions and substance use disorders can greatly impact maternal morbidity and mortality. Other articles in the journal discuss the non-scientific aspects of medicine, such as implementation science, patient experience, and cost-effectiveness. The emotional impact of medical interventions, the relationship between pelvic floor dysfunction and body image disturbance, and the cost-effectiveness of treatment strategies for cervical intraepithelial neoplasia are also explored. Additionally, the journal provides information on pregnancy outcomes for people with chronic kidney disease, the relationship between perineal wound complications and obstetric anal sphincter injury, the impact of hormonal contraceptives on endometriosis, the use of prophylactic ureteric catheterization during gynecologic surgery, and the prevalence of congenital eye anomalies. The issue also includes a paper on confounder selection in Obstetrics and Gynecology studies, emphasizing the importance of accurate interpretation of data. [Extracted from the article]

The article presents several abstracts of research papers presented at the fourth National Conference of Association of Obstetric Anesthesia and the Obstetric Anesthesia Society Asia Oceania (OASAO) Conference held in Hyderabad, India, September 16-18, 2011 on topics including labor analgesia of Indian pregnant women, a 10-year retrospective analysis of mortality in critically ill pregnant patients labor analgesia on previous LSCS patient.

Background: Obstetric critical illness is an important factor that leads to an increase in maternal mortality. Early warning assessment can effectively reduce maternal and neonatal mortality and morbidity. However, there are multiple early warning systems, and the effect and applicability of each system in China still need to be explored. Objectives: To elaborate on the application, effectiveness and challenges of the existing early warning systems for high‐risk obstetric women in China and to provide a reference for clinical practice. Design: A scoping review guided by the Arksey and O'Malley framework and reported using the Preferred Reporting Items for Systematic Reviews and Meta‐Analysis for scoping review (PRISMA‐ScR) guidelines. Eligibility criteria: We included original studies related to early warning and excluded those that were guidelines, consensus and reviews. The included studies were published in Chinese or English by Chinese scholars as of June 2021. Data sources: CNKI, Wanfang, VIP, Cochrane, CINAHL, Embase, PubMed and Web of Science databases were searched systematically, and the reference sections of the included papers were snowballed. Results: In total, 598 articles were identified. These articles were further refined using keyword searches and exclusion criteria, and 17 articles met the inclusion criteria. We extracted data related to each study's population, methods and results. Early warning tools, outcome indices, effects and challenges are discussed. Conclusions: Although all studies have shown that early warning systems have good application effects, the use of early warning systems in China is still limited, with poor regional management and poor sensitivity for specific obstetric women. Future research needs to develop more targeted early warning tools for high‐risk obstetric women and address the current challenges in clinical applications. [ABSTRACT FROM AUTHOR]

The United States continues to favor heavily medicalized childbirth, an approach that strips agency from birthing women and contains higher risks of complications and maternal death, especially for women of color. Mainstream popular culture has also misrepresented heavily medicalized birth as safer than deliveries with fewer interventions. The rise of post-apocalyptic narratives has introduced a new lens on mediated birthing experiences. In dystopic realities, women deliver without the existence of functioning hospitals or practicing physicians. This paper uses a narrative analysis of pregnancy, labor, and birth on The Walking Dead (2010-) A Quiet Place (2018), and Bird Box (2018). Findings suggest that these texts reinforce a narrow image of pregnant women and present a distorted picture of the birthing process. Moreover, even in a dystopia, these constructions reinforce the medical model of childbirth. Overall, such narrativesKatie.Foss@mtsu.edu [ABSTRACT FROM AUTHOR]

Background: Many low- and middle-income countries cannot measure maternal mortality to monitor progress against global and country-specific targets. While the ultimate goal for these countries is to have complete civil registrations systems, other interim strategies are needed to provide timely estimates of maternal mortality. Objective: The objective is to inform on potential options for measuring maternal mortality. Methods: This paper uses a case study approach to compare methodologies and estimates of pregnancy-related mortality ratio (PRMR)/maternal mortality ratio (MMR) obtained from four different data sources from similar time periods in Bangladesh, Mozambique, and Bolivia—national population census; post-census mortality survey; household sample survey; and sample vital registration system (SVRS). Results: For Bangladesh, PRMR from the 2011 census falls closely in line with the 2010 household survey and SVRS estimates, while SVRS' MMR estimates are closer to the PRMR estimates obtained from the household survey. Mozambique's PRMR from household survey method is comparable and shows an upward trend between 1994 and 2011, whereas the post-census mortality survey estimated a higher MMR for 2007. Bolivia's DHS and post-census mortality survey also estimated comparable MMR during 1998–2003. Conclusions: Overall all these data sources presented in this paper have provided valuable information on maternal mortality in Bangladesh, Mozambique, and Bolivia. It also outlines recommendations to estimate maternal mortality based on the advantages and disadvantages of several approaches. Contribution: Recommendations in this paper can help health administrators and policy planners in prioritizing investment for collecting reliable and contemporaneous estimates of maternal mortality while progressing toward a complete civil registration system. [ABSTRACT FROM AUTHOR]

Effective, low-cost clinical interventions to improve facility-based care during childbirth are critical to reduce maternal and perinatal mortality and morbidity in low-resource settings. While health interventions for low- and lower-middle-income countries are often developed and implemented top-down, needs and circumstances vary greatly across locations. Our pilot study in Zanzibar improved care through locally co-created intrapartum clinical practice guidelines (CPGs) and associated training (the PartoMa intervention). This intervention was context-tailored with health-care providers in Zanzibar and now scaled up within five maternity units in Dar es Salaam, Tanzania. This PartoMa Scale-up Study thereby provides an opportunity to explore the co-creation process and modification of the intervention in another context and how scale-up might be successfully achieved. The overall protocol is presented in a separate paper. The aim of the present paper is to account for the Scale-up Study's programme theory and qualitative methodology. We introduce social practice theory and argue for its value within the programme theory and towards qualitative explorations of shifts in clinical practice. The theory recognizes that the practice we aim to strengthen – safe and respectful clinical childbirth care – is not practiced in a vacuum but embedded within a socio-material context and intertwined with other practices. Methodologically, the project draws on ethnographic and participatory methodologies to explore current childbirth care practices. In line with our programme theory, explorations will focus on meanings of childbirth care, material tools and competencies that are being drawn upon, birth attendants' motivations and relational contexts, as well as other everyday practices of childbirth care. Insights generated from this study will not only elucidate active ingredients that make the PartoMa intervention feasible (or not) but develop the knowledge foundation for scaling-up and replicability of future interventions based on the principles of co-creation and contextualisation. [ABSTRACT FROM AUTHOR]

Background: Cesarean delivery (CD) rates have been increasing annually. For pregnant women, lack of analgesia affects maternal postpartum recovery, as well as breastfeeding and baby development, in addition to increasing the risk of postpartum depression. Aim: To evaluate, through a literature review, the analgesic effects of intrathecal morphine (ITM) and transversus abdominis plane (TAP) block on DC. Method: This is an exploratory study, based on the literature review method with evidence synthesis. The database chosen for the selection of papers was PUBMED, using the following search strategy: "intrathecal morphine"[title] AND ("tap block"[title] OR "transversus abdominis plane block"[title]) AND cesarean. Results: The search occurred in November 2022, and 11 papers that met the search strategy were initially identified. After reading the titles and abstracts, 2 texts were excluded because they were letters to the editor. Conclusion: The analgesic effects of ITM after DC seem to be superior to TAP blockade, although some studies indicate that both methods are comparable. However, TAP block would be a reasonable alternative when ITM is contraindicated, or even for patients at high risk of postoperative nausea and vomiting, in addition to presenting fewer adverse reactions compared to ITM. [ABSTRACT FROM AUTHOR]

Background: Difficulty in transportation to access skilled providers has been cited repeatedly as a major barrier to utilization of emergency obstetric care in Nigeria. Objective: The objective of this paper is to describe the design, implementation, and outcomes of a mobile phone technology aimed at rapidly reaching rural Nigerian women who experience pregnancy complications with emergency transportation and access to providers. Method: The project was implemented in 20 communities in two predominantly rural Local Government Areas (LGAs) of Edo State, in southern Nigeria, as part of a larger implementation project aimed at improving the access of rural women to skilled pregnancy care. The digital health innovation named Text4Life, allowed women to send a brief message from their mobile phone to a server linked to Primary Health Care (PHC) facilities and to access pre-registered transport owners. Pregnant women were registered and taught to text short messages to a server from their mobile phones or those of a friend or relative when they experience complications. Results: Over 18 months, 56 women out of 1620 registered women (3.5%) texted the server requesting emergency transportation. Of this number, 51 were successfully transported to the PHC facilities, 46 were successfully treated at the PHC, and five were referred to higher-level care facilities. No maternal deaths occurred during the period, while four perinatal deaths were recorded. Conclusion: We conclude that a rapid short message sent from a mobile phone to a central server and connected to transport providers and health facility managers is effective in increasing the access of pregnant women to skilled emergency obstetric services in rural Nigeria. [ABSTRACT FROM AUTHOR]

This research was conducted to evaluate the impacts of the Covid-19 pandemic on the socioeconomic status of South African women. There is an urgent need for a better understanding of the unique circumstances and provisional assistance of effective support for women throughout the Covid-19 crisis and its aftermath considering the level of impact the virus had on women. To achieve the researchobjective, a literaturebased analysis was employed, which provides an in-depth analysis and evaluation of previous literature on the unprecedented nature and trend of the Covid-19 pandemic and its impacts on the socioeconomic status of women in South Africa. Thus, despite the limited scientific data on the most recent development of the pandemic, the findings revealed that the pandemic has escalated most variables of socioeconomic status of women in South Africa, which include high poverty rates, increased rates of unplanned pregnancy, school drop-out of schoolgirls and child labour among teenage girls, lack of income, decreased financial empowerment, reduced access to conducive healthcare, excessive maternal mortality, and growing food shortages and malnutrition. Thus, as the world continues to search for a reliable vaccine and other preventive measures for the virus, this paper recommended that policymakers and stakeholders around the globe, and most especially in South Africa, should develop coherent and strategic policies that will incorporate and attend to the socioeconomic needs of women. [ABSTRACT FROM AUTHOR]

Low and middle-income countries continue to use Verbal autopsies (VAs) as a World Health Organisation-recommended method to ascertain causes of death in settings where coverage of vital registration systems is not yet comprehensive. Whilst the adoption of VA has resulted in major improvements in estimating cause-specific mortality in many settings, well documented limitations have been identified relating to the standardisation of the processes involved. The WHO has invested significant resources into addressing concerns in some of these areas; there however remains enduring challenges particularly in operationalising VA surveys for deaths amongst women and children, challenges which have measurable impacts on the quality of data collected and on the accuracy of determining the final cause of death. In this paper we describe some of our key experiences and recommendations in conducting VAs from over two decades of evaluating seminal trials of maternal and child health interventions in rural Ghana. We focus on challenges along the entire VA pathway that can impact on the success rates of ascertaining the final cause of death, and lessons we have learned to optimise the procedures. We highlight our experiences of the value of the open history narratives in VAs and the training and skills required to optimise the quality of the information collected. We describe key issues in methods for ascertaining cause of death and argue that both automated and physician-based methods can be valid depending on the setting. We further summarise how increasingly popular information technology methods may be used to facilitate the processes described. Verbal autopsy is a vital means of increasing the coverage of accurate mortality statistics in low- and middle-income settings, however operationalisation remains problematic. The lessons we share here in conducting VAs within a long-term surveillance system in Ghana will be applicable to researchers and policymakers in many similar settings. [ABSTRACT FROM AUTHOR]

Background: Women with rheumatic heart disease (RHD) can have a lower cardiac reserve to cope with pregnancy and labour, leading to increased obstetric and cardiac risks. The Northern Territory has been repeatedly reported to have the highest prevalence of RHD in Australia, yet evidence specific to pregnancy is scarce in the literature. Aims: The primary aim of this paper is to describe the baseline characteristics and maternal outcomes of pregnant women with RHD presenting to the largest obstetrics referral hospital in the Northern Territory. The secondary aim is to evaluate the current model of care in relation to their cardiac status. Methods: A retrospective observational study was conducted over a 9.5‐year period. Demographics, cardiac, obstetrics and anaesthetics data were collected for analysis. Results: One hundred and twenty‐nine pregnancies were included for analysis. All women were identified as Aboriginal or Torres Strait Islander, and 85% were of a RHD priority of 2 or 3. Of all 28 patients who had an emergency caesarean section, only one patient was indicated for cardiac reasons. There was no maternal or neonatal death reported. Three preterm births were induced secondary to maternal concerns related to RHD cardiac decompensation. There were no major adverse neonatal outcomes, including neonatal death, intraventricular haemorrhage or respiratory distress syndrome. Multidisciplinary care was also evaluated. Conclusion: We observed a low rate of maternal and fetal morbidity and no mortality in a cohort of women with mild to severe RHD. These favourable outcomes have occurred in a multidisciplinary centre with significant experience in managing the medical and cultural complexities of this group. [ABSTRACT FROM AUTHOR]

In this article, we aimed to evaluate the most recent information on the impact of the COVID-19 pandemic on the health of mothers and their babies. We conducted a literature search by utilizing online sources. Scientific papers that were written in English on the effects of COVID-19 on both mother and their newborn were assessed. COVID-19 can be fatal, especially in pregnant women with accompanying chronic diseases. The timing and mode of delivery should be decided by the status of the mother and fetus instead of SARS-CoV-2 positivity in pregnant women. At the nursery, routine separation of SARS-CoV-2 positive mothers and their infants is not recommended. However, it is important to take preventive measures to reduce the risk of transmission. The advantages of breastfeeding seem to outweigh the potential dangers of viral transmission. Neonatal COVID-19 infections may cause different clinical pictures from asymptomatic infections to life-threatening diseases. International health authorities specifically recommend that pregnant and lactating women get vaccinated to diminish the risk of transmission of the virus to the mother and fetus, not giving preference to a certain vaccine. It is prudent to apply universal screening only in populations with a high prevalence of COVID-19. Healthcare professionals should carefully manage the perinatal period during the COVID-19 outbreak, using the most up-to-date information to protect and promote maternal and newborn health. Further scientific studies are needed to clarify the early and long-term effects of the COVID-19 pandemic on maternal-neonatal morbidity and mortality. [ABSTRACT FROM AUTHOR]

Hypertensive syndrome in pregnancy complicates up to 15% of pregnancies, and preeclampsia (PE) occurs in about 3–10% of pregnant women. Inadequate prenatal care is associated with higher mortality from PE, possibly due to reduced monitoring, detection, and missed opportunities for early intervention. The imperative of the clinician's work is to monitor the symptoms and clinical signs of PE, and stratification of patients in relation to the risk of PE is essential. PE represents a multisystem inflammatory response, and the consequences can be expected in all organs. The question of the effect of PE on long-term maternal health is raised. The aim of the paper is to present the effect of PE on the patient's health through the prism of low-income countries. [ABSTRACT FROM AUTHOR]

Background: Maternal mortality in the United States is a public health crisis and national emergency. Missed or delayed recognition of preventable life-threatening symptoms and untimely treatment of preventable high-risk medical conditions have been cited as key contributors to the nation's worsening mortality rates. Effective strategies are urgently needed to address this maternal health crisis, particularly for Black birthing populations. Morbidity and Mortality Assessment: Lifting Outcomes Via Education (MAMA LOVE) is a web-based platform that focuses on the identification of maternal morbidity and mortality risk factors. Objective: The purpose of this paper is to present the conceptualization, development, heuristics, and utility evaluation of the web-based maternal mortality risk assessment and educational tool MAMA LOVE. Methods: A user-centered design approach was used to gain feedback from clinical experts and potential end users to ensure that the tool would be effective among groups most at risk for maternal morbidity and mortality. A heuristic evaluation was conducted to evaluate usability and need within the current market. Algorithms describing key clinical, mental health, and social conditions were designed using digital canvas software (Miro) and incorporated into the final wireframes of the revised prototype. The completed version of MAMA LOVE was designed in Figma and built with the SurveyJS platform. Results: The creation of the MAMA LOVE tool followed three distinct phases: (1) the content development and creation of an initial prototype; (2) the feedback gathering and usability assessment of the prototype; and (3) the design, development, and testing of the final tool. The tool determines the corresponding course of action using the algorithm developed by the authors. A total of 38 issues were found in the heuristic evaluation of the web tool's initial prototype. Conclusions: Maternal morbidity and mortality is a public health crisis needing immediate effective interventions. In the current market, there are few digital resources available that focus specifically on the identification of dangerous symptoms and risk factors. MAMA LOVE is a tool that can address that need by increasing knowledge and providing resources and information that can be shared with health care professionals. [ABSTRACT FROM AUTHOR]

aimanot Abebe Adane,1 Tadele Girum,1 Wako Golicha Wako21Department of Public Health, Wolkite University, Wolkite, Southwest Region, Ethiopia; 2School of Public Health, Bule Hora University, Bule Hora, South Region, EthiopiaCorrespondence: Abebaw Wasie Kasahun Email [email protected] Background: Ethiopia has made great strides on under-five and maternal mortality reduction as demonstrated by achieving the millennium development target of child mortality reduction by the start of 2015. According to a recent demographic and health survey report, Ethiopia has a 67 per 1000 under-five mortality rate and a 412 per 100,000 live births maternal mortality ratio. The current trend of maternal and child mortality reduction is not enough to meet sustainable development goal three (SDG3) of maternal and child mortality reduction target which is set to reduce the maternal mortality ratio to below 70/100,000 live births in all countries. This paper aimed to model the effect of scaling up family planning on pregnancies, live births, stillbirths, abortions and maternal mortality in Ethiopia. Methods: We used the Spectrum software package to model the impact of family planning on maternal survival and other maternal health metrics. Spectrum has different modules consisting of demproj module (demographic projection), famplan module (family planning), LiST (life saved tool), and AIM (aids impact model). We used Demproj, Famplan and LiST modules for this particular paper. Baseline national data were taken from findings of the Ethiopian demographic and health survey 2016, and World Bank and World Health Organization country specific reports. Results: Total fertility rate will decline to 2.3 children per women by the year 2030 when contraceptive prevalence is scaled up by 2% annually from 2016 to 2030. As a result of continuous scaling up of contraceptive use, around 3.17 million unintended pregnancies can be averted. Unmet need for family planning will significantly decline to 11.7% by 2030. Ninety-four thousand unsafe abortions could be averted and 1233 additional maternal lives could be saved by the end of 2030 in Ethiopia. Conclusion: Scaling up family planning has shown a significant effect to meet the SDG3 maternal mortality reduction target. A considerable proportion of unintended pregnancies and unsafe abortions can be averted by scaling up contraceptive prevalence by 2% annually until 2030. Family planning is effective and a less costly intervention to reduce maternal mortality in countries with high fertility; hence, it is highly recommended to rampup all efforts to scale up contraceptive use for improving maternal health status in Ethiopia. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to evaluate the training and implementation of the gravimetric method for estimating postpartum blood loss in clinical practice in Indonesian midwife-led birth centres. Background: Postpartum haemorrhage remains a leading cause of maternal death, particularly in low-resource settings. There is no gold standard for assessing blood loss volume during labour and childbirth. Studies recommended using a gravimetric method to measure blood loss in low-resource settings due to its relative accuracy and simplicity. Study design and methods: An online training module for the use of the gravimetric method was developed. All participants undertook the training and were asked to implement the method in clinical practice. A pre/post-test study design was used to examine midwives' understanding of the gravimetric method; their implementation experience was explored using a structured questionnaire. Knowledge was assessed pre-training. The training consisted of both theoretical and practical elements and the opportunity for participants to ask questions. Post-training tests were administered, followed by a one-month period of implementation and an evaluation of their experience of using the method in practice. Results: Two hundred and eighty-five midwives from 17 health facilities were recruited to the study, and a total of 101 midwives from 12 health facilities completed all elements. The participants' understanding of the gravimetric method improved significantly following the training. Although a number of challenges were identified regarding the implementation of the gravimetric method in practice, the participants were generally positive about its use, and 89% said that they would recommend this method to colleagues. Conclusion: A three-hour online training effectively improved participants' understanding of the gravimetric method for assessing blood loss volume. This study identified midwives' positive experiences with the gravimetric method and identified areas to improve practitioner experience of implementation in practice. Implications for research, policy, and practice: A three-hour online training followed by a onemonth implementation period could be an effective and efficient approach to developing midwives' understanding and use of the gravimetric method of blood loss estimation postpartum. What is already known about the topic? * The gravimetric method estimates the blood loss volume by weighing sanitary materials used during the labour process (i.e., gauze, sheets, swabs, pads, etc.) before and after being contaminated by the blood. * In clinical practice, the weight difference (in grams) is considered as 'blood loss volume' for ease of measurement and reported in millilitres without any formal conversion of units of weight to volume. * The benefits of the gravimetric method have been reported previously. However, there is limited evidence on the evaluation of this method to train midwives regarding implementation of the gravimetric method in clinical practice. What this paper adds * An online training programme is effective in increasing midwives' knowledge and awareness of the gravimetric method for postpartum blood loss assessment. * The midwives found the gravimetric method simple to adopt in clinical practice, which increased their confidence in detecting postpartum haemorrhage. * The midwives encountered some barriers while implementing the gravimetric method and provided strategies to mitigate the issues raised. [ABSTRACT FROM AUTHOR]

In recent years, the increase in cases of postpartum hemorrhage in Brazil has made this topic the subject of numerous scientific investigations. The literature shows that postpartum hemorrhage is a strong conditioner of death and, therefore, has become the second cause of maternal death in Brazil considering the studies by Lima (2019). Moreover, postpartum hemorrhage is understood as any type of bleeding with a lost blood volume greater than 500 ml after vaginal deliveries and 100 after cesarean deliveries. Still on the subject, trauma of the vaginal canal, as well as placental retention or coagulation problems are considered the main conditioning factors. In this sense, the present study aimed to analyze the main practices of prevention and treatment of postpartum hemorrhage considering the current literature. We opted for integrative literature review, considering the main original studies published between 2019 and 2022, as well as from the descriptors postpartum hemorrhage, prevention and treatment of postpartum hemorrhage and women's health. Of the 60 papers found, 10 met the inclusion criteria and were used for analysis. The results showed that the management and selection of technique varies according to the patient's situation and that use of medication, management of the umbilical cord; uterine massage are the most recurrent. Moreover, it is highlighted the prevention of bleeding considering all gestational analysis of the woman, as well as fast and effective management in order to preserve the patient's life and decrease the number of deaths resulting from this health problem. [ABSTRACT FROM AUTHOR]

Background: Since 2005, India has experienced an impressive 77% reduction in maternal mortality compared to the global average of 43%. What explains this impressive performance in terms of reduction in maternal mortality and improvement in maternal health outcomes? This paper evaluates the effect of household wealth status on maternal mortality in India, and also separates out the performance of the Empowered Action Group (EAG) states and the Southern states of India. The results are discussed in the light of various pro-poor programmes and policies designed to reduce maternal mortality and the existing supply side gaps in the healthcare system of India. Using multiple sources of data, this study aims to understand the trends in maternal mortality (1997-2017) between EAG and non EAG states in India and explore various household, economic and policy factors that may explain reduction in maternal mortality and improvement in maternal health outcomes in India.Methods: This study triangulates data from different rounds of Sample Registration Systems to assess the trend in maternal mortality in India. It further analysed the National Family Health Surveys (NFHS). NFHS-4, 2015-16 has gathered information on maternal mortality and pregnancy-related deaths from 601,509 households. Using logistic regression, we estimate the association of various socio-economic variables on maternal deaths in the various states of India.Results: On an average, wealth status of the households did not have a statistically significant association with maternal mortality in India. However, our disaggregate analysis reveals, the gains in terms of maternal mortality have been unevenly distributed. Although the rich-poor gap in maternal mortality has reduced in EAG states such as Bihar, Odisha, Assam, Rajasthan, the maternal mortality has remained above the national average for many of these states. The EAG states also experience supply side shortfalls in terms of availability of PHC and PHC doctors; and availability of specialist doctors.Conclusions: The novel contribution of the present paper is that the association of household wealth status and place of residence with maternal mortality is statistically not significant implying financial barriers to access maternal health services have been minimised. This result, and India's impressive performance with respect to maternal health outcomes, can be attributed to the various pro-poor policies and cash incentive schemes successfully launched in recent years. Community-level involvement with pivotal role played by community health workers has been one of the major reasons for the success of many ongoing policies. Policy makers need to prioritise the underperforming states and socio-economic groups within the states by addressing both demand-side and supply-side measures simultaneously mediated by contextual factors. [ABSTRACT FROM AUTHOR]