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Prenatal care and infant mortality rates are crucial indicators of healthcare quality. However, millions of women in low‐income countries lack access to adequate care. Factors such as high‐risk pregnancies and unmanaged diet increase the risk of developing complications during pregnancy, highlighting the need for continuous monitoring of maternal health. The increasing burden of non‐communicable diseases represents a significant threat to fragile health systems. The lack of access to appropriate prenatal care and poor maternal and newborn health outcomes are major concerns in low‐ and middle‐income countries (LMICs). It emphasizes the need for innovative, integrative approaches to healthcare delivery, especially in pregnant women. The health services need to be reorganized holistically and effectively, focusing on factors that directly impact maternal, neonatal, and infant mortality, resulting in improved access to maternity services and survival of "at‐risk" mothers and their offspring in many LMICs. Based on the FIGO (the International Federation of Gynecology & Obstetrics) recommendations of extending preconception care to the postpartum stage, the authors of this review have developed a new model of care—PregCare—based on the triple‐intervention‐based holistic and multidisciplinary maternal and fetal medicine model for low‐risk pregnancies. This model will help transform the traditional model's high visitation frequency into a safe and reduced office visit, while increasing virtual connections, point of care and self‐care with doctors, nurses, and community‐based providers of self‐care. This shall be based on a sophisticated central PregCare call center powered by innovative technologies combined with experienced personnel in perinatal management (doctors and nurses/midwives). Digital technologies have revolutionized healthcare delivery, expanded treatment options, and improved precision in targeting specific conditions and patient types. In the realm of maternal health, there is a growing recognition of the need for a comprehensive approach encompassing prenatal care, long‐term health care, and integration with existing health programs and services. [ABSTRACT FROM AUTHOR]

Objectives: The authors aimed to assess the characteristics and integration of immunization services into the prenatal care provided by maternity care units (MCUs) in Italy. Methods: A cross‐sectional nationwide study using a web‐based survey was conducted from June to August 2021. The study population consisted of 342 obstetricians/gynecologists (OB/GYNs), members of the Italian Society of Gynecology and Obstetrics, and heads of MCUs. The main outcome was to assess the performance of several vaccine‐related services among the surveyed MCUs. Results: Overall, 112 of 342 MCUs completed the survey, for an overall response rate of 32.7%. Almost all MCUs (96.4%) provided vaccine information, but only 22% had an onsite vaccination clinic. Less than half (43.8%) offered vaccines during prenatal visits and 75% of those sites required women to set up an extra appointment for vaccination. Although 68% MCUs recorded vaccines administered, only 20% of them managed to record vaccines in their own medical records. The institutional‐logistic issues were the most voted vaccination barrier (40.2%). Conclusions: Institutional barriers and lack of certain vaccine‐related services offered during prenatal care in Italian MCUs might be responsible for many missed vaccination opportunities. Embedding maternal immunization programs within the current prenatal care services might optimize vaccine coverage. Synopsis: The lack of integration between maternal immunization programs and prenatal care services might represent a significant barrier that prevents maternal care providers from recommending and offering vaccines to pregnant women. [ABSTRACT FROM AUTHOR]

After the declaration of the Millennium Development Goals in 2000 by the United Nations, many stakeholders allocated financial resources to "global maternal health." Research to expand care and improve delivery of maternal health services has exponentially increased. The present article highlights an overview, namely 10 of the health system, clinical, and technology-based advancements that have occurred in the past three decades in the field of global maternal health. The list of topics has been selected through the cumulative clinical and public health expertise of the authors and is certainly not exhaustive. Rather, the list is intended to provide a mapping of key topics arranged from broad to specific that span from the global policy level to the level of individual care. The list of health system, clinical, and technology-based advancements include: (10) Millennium Development Goals and Sustainable Development Goals; (9) Development of clinical training programs, including the potential for subspecialty development; (8) Prenatal care expansion and potential; (7) Decentralized health systems, including the use of skilled birth attendants; (6) Antiretroviral therapy for HIV; (5) Essential medicines; (4) Vaccines; (3) mHealth/eHealth; (2) Ultrasonography; and (1) Obstetric hemorrhage management. With the Sustainable Development Goals now underway, the field must build upon past successes to sustain maternal and neonatal well-being in the future global health agenda. [ABSTRACT FROM AUTHOR]

Objective: To investigate perceptions of early pregnancy assessment units (EPAUs) among perinatal practitioners working in Belgium, France, and Switzerland.Methods: A prospective multinational survey was conducted between September 1, 2015, and May 21, 2016. Obstetricians, gynecologists, medical doctors, radiologists, and midwives were recruited during meetings, via e-mail invitations, or through the websites of regional obstetrics and gynecology scientific societies. The survey comprised 17 questions that assessed the participants' knowledge, interest, and management of early pregnancy.Results: Of the 871 individuals invited to participate in the survey, 306 (35.1%) responded. Most of the participants were gynecologists and/or obstetricians (225 [73.5%]). A total of 258 (84.3%) participants had no or limited knowledge about EPAUs. Furthermore, 211 (69.0%) participants reported incorrect management when they visualized a gestational sac without embryo and 265 (86.6%) misinterpreted changes in serum levels of chorionic gonadotropin during early pregnancy. In all, 201 (65.7%) participants were interested in collaboration with an EPAU; however, only 125 (40.8%) had sufficient time and resources available to support a patient's psychological distress after early pregnancy loss or salpingectomy.Conclusion: Knowledge about early management of pregnancy was limited among the perinatal practitioners surveyed; however, the concept of EPAUs was welcomed by many. [ABSTRACT FROM AUTHOR]

Objective: To assess birth preparedness and complication readiness (BPCR) as well as knowledge of danger signs during pregnancy, labor/delivery, and the postpartum period.Methods: A cross-sectional study was undertaken of pregnant women attending the prenatal clinic at a tertiary hospital in Nigeria between October and December 2016. A pretested and structured questionnaire was used to collect data on BPCR, and logistic regression was performed to determine factors affecting BPCR.Results: Of 325 participants, 274 (84.3%) had knowledge of BPCR components, and 265 (81.5%) were well prepared for birth and its complications. However, only 89 (27.4%) knew key danger signs during labor/delivery and 81 (24.9%) knew those in the first 2 days after delivery. Older age, higher parity, tertiary education of women, paid employment of women and their spouses, higher social class, frequent prenatal visits, and knowledge of danger signs were significantly associated with BPCR (P<0.05). Higher parity, maternal government employment, and knowledge of danger signs during pregnancy remained determinants of BPCR on logistic regression (P<0.05).Conclusion: Although there was a high level of knowledge and practice of BPCR, knowledge of key danger signs was low. Therefore, prenatal education needs to be improved with an emphasis on teaching pregnant women to recognize key danger signs. [ABSTRACT FROM AUTHOR]

Objective: To compare severe maternal complications (potentially life-threatening conditions [PLTCs], maternal near miss [MNM], and maternal death) and perinatal outcomes between multiple and singleton pregnancies.Methods: A secondary analysis was undertaken using data from the Brazilian Network for Surveillance of Severe Maternal Morbidity (prospective surveillance of morbidities in 27 Brazilian obstetric units between July 2009 and June 2010). Health indicators and criteria used for PLTCs and MNM were assessed. Adjusted prevalence ratios (PRadj ) with 95% confidence intervals (CIs) were calculated for perinatal outcomes.Results: Among 267 multiple pregnancies, 235 (88.0%) were affected by PLTCs, 25 (9.4%) by MNM, and 7 (2.6%) by maternal death; these prevalences did not differ from singleton pregnancies (n=7986). Management criteria for MNM were used almost twice as much in multiple pregnancies (PRadj 1.85, 95% CI 1.41-2.42). Preterm birth (PRadj 1.62, 95% CI 1.41-1.86), low birthweight (PRadj 1.73, 95% CI 1.45-2.06 for the first-born vs singleton), any adverse perinatal outcome (PRadj 1.12, 95% CI 1.03-1.22 for the second- vs first-born), and neonatal near miss (PRadj 1.37, 95% CI 1.13-1.67 for the second-born vs singleton) were significantly associated with multiple pregnancy.Conclusion: Among cases of severe maternal morbidity, perinatal but not maternal outcomes were poorer for multiple pregnancies than for singletons. Differentiated care is needed during pregnancy and childbirth. [ABSTRACT FROM AUTHOR]

Objective: To assess the quality of family planning counseling among women attending a prenatal clinic in Addis Ababa, Ethiopia.Methods: In a descriptive cross-sectional study conducted between February and April, 2015, at the prenatal care clinic of Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia, pregnant women in their third trimester were interviewed about their experience of family planning counseling. Data were collected via a questionnaire. Logistic regression was used to assess predictors of satisfaction with the counseling service.Results: During the study period, 400 women were interviewed. Only 139 women (34.8%) were counseled about family planning. Among those counseled, 126 (90.6%) decided to use a contraceptive method after delivery and 46 (36.7%) decided to use an injectable contraceptive. Women were more likely to report high satisfaction when their provider asked about their partner's attitude toward contraceptive methods (adjusted odds ratio 6.6; P<0.001), and when asked about their concerns and worries regarding family planning methods (adjusted odds ratio 5.1; P<0.001).Conclusion: Very few women were counseled about contraception during prenatal care. Asking about a partner's attitude toward contraceptives and discussing women's fears or worries about contraceptives should be considered during family planning counseling to improve satisfaction and quality of care. [ABSTRACT FROM AUTHOR]

Objective: To explore men's experience and beliefs regarding the use of maternity waiting homes (MWHs) in Kalomo District, Zambia.Methods: As part of a qualitative study, in-depth interviews with the husbands/partners of women attending the under-five clinic at a health center with a MWH were conducted between April 1 and May 31, 2014. Men aged 18-50 years whose partner/wife was of reproductive age and who had lived in the area for more than 6 months were eligible for inclusion.Results: Overall, 24 husbands/partners were interviewed in seven rural health centers. Men perceived many potential benefits of MWHs, including improved access to facility-based skilled delivery services and treatment in case of labor complications. Their many roles included decision making and securing funds for transport, food, cleaning materials, and clothes for the mother and the neonate to use during and after labor. However, limited financial resources made it difficult for them to provide for their wives and newborns, and usually led to delays in their decisions about MWH use. Poor conditions in MWHs and the lack of basic social and healthcare needs meant some men had forbidden their wives/partners from using the facilities.Conclusion: Important intervention targets for improving access to MWHs and skilled birth attendance have been identified. [ABSTRACT FROM AUTHOR]

Objective To establish the prevalence of symptoms of anxiety, depression, and post-traumatic stress disorder (PTSD) among women attending prenatal care in Tanzania, and identify associated factors. Methods A cross-sectional study was conducted of one in five physically well women attending a prenatal-care clinic in Muhimbili National Hospital, Dar es Salaam, between December 2011 and April 2012. Trained research assistants carried out face-to-face interviews using a structured questionnaire. The Hopkins Symptoms Checklist and the PTSD Diagnostic Scale were used to establish levels of depression and anxiety symptoms. Results Among the 1180 women interviewed, 905 (76.7%) had symptoms of anxiety, 923 (78.2%) had symptoms of depression, and 58 (4.9%) had moderate/severe PTSD symptoms. After adjustment for women’s sociodemographic characteristics, age of the woman and their partner, educational level of the woman and their partner, relationship duration, employment, and marital status were associated with symptoms of at least one of the three mental disorders ( P < 0.05 for all). Conclusion Many pregnant women had symptoms of mental health disorders. Screening of mental health disorders during prenatal care and training of healthcare providers are needed. [ABSTRACT FROM AUTHOR]

Objective To evaluate differences in obstetric care between immigrant and native women in a country with free access to health care. Methods A cross-sectional study was carried out of immigrant mothers delivering in one of the four public hospitals in the Porto, Portugal, metropolitan area between February and December 2012. The comparison group included native Portuguese mothers who delivered in the same institutions. The participants (89 immigrant mothers and 188 Portuguese mothers) were recruited by telephone and completed a written questionnaire during a home visit. Results Immigrant women were more likely to have their first pregnancy appointment after 12 weeks of pregnancy (27.0% vs 14.4%, P = 0.011) and to have fewer than three prenatal visits (2.2% vs 0.0%, P < 0.001). They were also more likely to have had a cesarean delivery (48.3% vs 31.4%, P = 0.023), perineal laceration (48.8% vs 11.6%, P < 0.001), or postpartum hemorrhage (33.5% vs 12.3%, P < 0.001). Conclusion Migrants were more prone to late prenatal care and to intrapartum complications. Unsatisfactory interactions with healthcare staff may play an important role in these findings. [ABSTRACT FROM AUTHOR]

Objective: To explore maternal healthcare utilization in rural western China, and to analyze the socioeconomic and demographic determinants associated with use of maternal health services.Methods: Between July and August 2005, 14112 women from 45 counties in 10 western provinces of China were enrolled in a cross-sectional study by a multi-stage probability sampling method. The women completed a structured questionnaire, and a 2-level logistic regression model was used to examine the data.Results: The proportion of women who had prenatal care was 95%. The average number of prenatal visits was 4.94. The proportion of women who had more than 4 prenatal visits was 52.9%, and 66.9% of these had their first prenatal visit within 12 weeks of gestation. The hospital delivery rate was 86.3%. The frequency of postnatal visits was 84.8%, and the average number of postnatal visits was 2.19. Han ethnicity, higher education, lower parity, higher wealth index, and lower altitude of county had a higher odds ratio for more than 4 prenatal visits, hospital delivery, and postnatal visits.Conclusion: Maternal healthcare utilization seems to be associated with socio-economic and regional factors. The Chinese government should focus on the supply, funding, and quality of maternity services in rural areas. [ABSTRACT FROM AUTHOR]

Objective: To determine risk factors for perinatal mortality among hospital-based deliveries in Nigeria.Methods: The WHO Global Maternal and Perinatal Health Survey was implemented in Nigeria as a first step in establishing a global system for monitoring maternal and perinatal health. Twenty-one health facilities with more than 1000 deliveries annually were selected by a stratified multistage cluster sampling strategy. Information was recorded on all women who delivered and their neonates within a 3-month period.Results: Overall, there were 9208 deliveries, comprising 8526 live births, 369 fresh stillbirths, 282 macerated stillbirths, 70 early neonatal deaths, and 721 perinatal deaths. The stillbirth and perinatal mortality rates were, respectively, 71 and 78 per 1000 deliveries; the early neonatal death rate was 8 per 1000 live births. Approximately 10% of all newborns weighed less than 2500 g, and 12.3% were born at less than 37 weeks of gestation. Predictors of perinatal mortality were mother's age, lack of prenatal care, unbooked status, prematurity, and birth asphyxia.Conclusion: The perinatal mortality rate remains unacceptably high in Nigeria. Fresh stillbirth accounted for most perinatal deaths. Interventions to improve the utilization and quality of prenatal care, in addition to the quality of intrapartum care, would considerably reduce perinatal death. [ABSTRACT FROM AUTHOR]

Objective: We assessed the effect of prenatal and peripartum antibiotics on maternal morbidity and mortality among HIV-infected and uninfected women.Methods: A multicenter trial was conducted at clinical sites in 4 Sub-Saharan African cities: Blantyre and Lilongwe, Malawi; Dar es Salaam, Tanzania; and Lusaka, Zambia. A total of 1558 HIV-infected and 271 uninfected pregnant women who were eligible to receive both the prenatal and peripartum antibiotic/placebo regimens were enrolled. Pregnant women were interviewed at 20-24 weeks of gestation and a physical examination was performed. Women were randomized to receive either antibiotics or placebo. At the 26-30 week visit, participants were given antibiotics or placebo to be taken every 4 hours beginning at the onset of labor and continuing after delivery 3 times a day until a 1-week course was completed. Logistic regression and Cox proportional hazards models were used.Results: There were no significant differences between the antibiotic and placebo groups for medical conditions, obstetric complications, physical examination findings, puerperal sepsis, and death in either the HIV-infected or the uninfected cohort.Conclusion: Administration of study antibiotics during pregnancy had no effect on maternal morbidity and mortality among HIV-infected and uninfected pregnant women. [ABSTRACT FROM AUTHOR]

Objective: To describe the circumstances of occurrence and identify potential risk factors for obstetric fistula in northern Cameroon.Methods: A case series study of 42 obstetric fistula patients seeking services at the Provincial Hospital of Maroua, Cameroon, between May 2005 and August 2007. Structured interviews were conducted prior to surgical intervention.Results: Among obstetric fistula patients, 60% had lived with obstetric fistula for more than 5 years at the time of surgery. Eighty-one percent of patients had received no formal education and 86% were teenagers at their first delivery. Regarding the pregnancy and delivery preceding the occurrence of the fistula, 50% of women reported that they had received no prenatal care and 76% were in labor for more than 12 hours. The majority (83%) of women delivered a stillborn baby.Conclusions: Obstetric fistula patients in the Far North Province of Cameroon had a low level of education, were married at a young age, and had poor access to quality maternal healthcare services. [ABSTRACT FROM AUTHOR]

Objective: To investigate Sri Lankan maternal deaths due to heart disease and to consider low-cost interventions to reduce these deaths.Methods: A qualitative study based on retrospective audit of all maternal deaths and late maternal deaths in Sri Lanka caused by cardiac disease in 2004.Results: A total of 145 maternal deaths were recorded in 2004, for a maternal mortality rate of 38 per 100,000. There were 42 indirect deaths, 25 of which were due to cardiac disease; 23 deaths had a specific cardiac cause listed. Standard care was identified in prepregnancy counseling, contraception, and prenatal community and specialist care.Conclusion: Cardiac disease is a major cause of maternal mortality in Sri Lanka, second only to postpartum hemorrhage. Rheumatic mitral valve disease is responsible for more than a third of maternal deaths from cardiac disease. Substandard care was identified in all cases; strategies to improve care could allow a reduction in maternal cardiac deaths. [ABSTRACT FROM AUTHOR]

Objective: Save the Children/USA and the Ministry of Health of Vietnam undertook a project between 2001 and 2004 to improve the availability of, access to, quality and utilization of emergency obstetric care (EmOC) services at district and provincial hospitals in two provinces in Vietnam.Methods: The project improved the functional capacity of 3 provincial and 1 district hospitals providing comprehensive EmOC services, and upgraded 1 district hospital providing basic EmOC into a comprehensive EmOC facility through training, infrastructure and quality improvement.Results: Data presented in this paper focus on only the 2 district hospitals even though the UN process indicators showed increases in utilization of EmOC in all 5 hospitals. In the case of Hai Lang, the proportion of births increased from 13% at baseline to 31% at the end of 2004, and met need increased significantly from 16% to 87% largely due to increased capacity of the hospital and staff. Met need in Hoang Hoa hospital more than doubled (17% at baseline versus 54% in 2004) and the proportion of births increased slightly from 19% in 2001 to 22% in 2004. Case fatality rates for the two hospitals remarkably remained at zero. Lessons from this project have been incorporated into national policy and guidelines.Conclusion: Improvements in the capacity of existing health facilities to treat complications in pregnancy and childbirth can be realized in a relatively short period of time and is an essential element in reducing maternal mortality. [ABSTRACT FROM AUTHOR]

Objective: To obtain descriptive measures of maternal and perinatal health in the Ba Men Region of Inner Mongolia, China.Methods: Data collected from the Examination Chart for Pregnant Women for approximately 22,000 pregnancies in a three-county area of Inner Mongolia, China from December 1, 1996 through December 31, 1999 were analyzed for maternal, perinatal, and neonatal outcomes.Results: Compared to selected developing countries, a higher percentage of women (99%) in this region received at least one prenatal care visit. This region was also characterized by a low percentage of low birthweight (<2.5 kg) infants (1%) and neonatal mortality rate (5 deaths per 1000 live births).Conclusions: Maternal and neonatal health outcomes in this region of Inner Mongolia were better than those in selected developing countries. [ABSTRACT FROM AUTHOR]

Purpose: We conducted a survey to determine availability of emergency obstetric care (EmOC) to provide baseline data for monitoring provision of obstetric care services in Uganda.Methods: The survey, covering 54 districts and 553 health facilities, assessed availability of EmOC signal functions. Following this, performance improvement process was implemented in 20 district hospitals to scale-up EmOC services.Findings: A maternal mortality ratio (MMR) of 671/100,000 live births was recorded. Hemorrhage, 42.2%, was the leading direct cause of maternal deaths, and malaria accounted for 65.5% of the indirect causes. Among the obstetric complications, abortion accounted for 38.9% of direct and malaria 87.4% of indirect causes. Removal of retained products (OR 3.3, P<0.002), assisted vaginal delivery (OR 3.3, P<0.001) and blood transfusion (OR 13.7, P<0.001) were the missing signal functions contributing to maternal deaths. Most health facilities expected to offer basic EmOC, 349 (97.2%) were not offering them. Using the performance improvement process, availability of EmOC in the 20 hospitals improved significantly.Conclusion: An integrated programming approach aiming at increasing access to EmOC, malaria treatment and prevention services could reduce maternal mortality in Uganda. [ABSTRACT FROM AUTHOR]

Objective: To improve the quality of clinical care for women with severe pre-eclampsia.Methods: A criteria-based audit was conducted in a large government hospital in Uganda. Management practices were evaluated against standards developed by an expert panel by retrospectively evaluating 43 case files. Results of the audit were presented, and recommendations developed and implemented. A re-audit was conducted 6 months later.Results: The initial audit showed that most standards were rarely achieved. Reasons were discussed. Guidelines were produced, additional supplies were purchased following a fundraising effort, labor ward procedures were streamlined, and staffing was increased. In the re-audit there were significant improvements in diagnosis, monitoring, and treatment.Conclusion: Criteria-based audit can improve the quality of maternity care in countries with limited resources. [ABSTRACT FROM AUTHOR]

Objective: To ascertain and compare compliance with UN emergency obstetric care (EmOC) recommendations by public health care centers in Pakistan's Punjab and Northwest Frontier Province (NWFP) provinces.Method: Cross-sectional data were collected from July through September 2003 using UN process indicators. From each province, 30% of districts (n=19); were randomly selected; all public health facilities providing EmOC services (n=170) were included.Results: The study found that out of 170 facilities only 22 were providing basic and 37 comprehensive EmOC services in the areas studied. Only 5.7% of births occurred in EmOC health facilities. Met need was 9% and 0.5% of women gave birth by cesarean section. The case fatality rate was a low 0.7%, probably due to poor record keeping. Access and several indicators were better in NWFP than in Punjab.Conclusion: Almost all indicators were below UN recommendations. Health policy makers and planners must take immediate, appropriate measures at district and hospital levels to reduce maternal mortality. [ABSTRACT FROM AUTHOR]

Purpose: We searched for evidence for the effectiveness of emergency obstetric care (EmOC) interventions in reducing maternal mortality primarily in developing countries.Methods: We reviewed population-based studies with maternal mortality as the outcome variable and ranked them according to the system for ranking the quality of evidence and strength of recommendations developed by the US Preventive Services Task Force. A systematic search of published literature was conducted for this review, including searches of Medline, PubMed, Cochrane Database of Systematic Reviews, the Cochrane Pregnancy and Childbirth Database and the Cochrane Controlled Trials Register.Results: The strength of the evidence is high in several studies with a design that places them in the second and third tier in the quality of evidence ranking system. No studies were found that are experimental in design that would give them a top ranking, due to the measurement challenges associated with maternal mortality, although many of the specific individual clinical interventions that comprise EmOC have been evaluated through experimental design. There is strong evidence based on studies, using quasi-experimental, observational and ecological designs, to support the contention that EmOC must be a critical component of any program to reduce maternal mortality. [ABSTRACT FROM AUTHOR]

The aim of this paper is to describe different approaches to make emergency obstetric care (EmOC) accessible to women in Mozambique. The definitions of basic (BEmOC) and comprehensive EmOC (CEmOC), proposed by the UN agencies, were adopted by FIGO and by the Mozambican Ministry of Health as a general strategy to reduce maternal mortality. Four projects are presented: (1) Jose´ Macamo and (2) Mavalane Hospitals in Maputo city, (3) Manhic¸a District in Maputo Province and (4) Sofala Province. Jose´ Macamo was staffed by physicians 24 h a day; other hospitals by non-physicians trained in surgical and anesthesiology techniques, as well as nurse-midwives. Jose´ Macamo Hospital provided CEmOC to the city of Maputo and the southern area of Maputo Province. In 2001, this hospital attended 32% of deliveries and 38% of cesarean sections in the city, up from 14 and 2.5%, respectively, in 1998. The Mavalane Hospital failed to provide CEmOC; however, the number of deliveries per year almost doubled. The Manhic¸a hospital carried out 31% of the District's C-sections in 2001, up from 9% in 1998. In Sofala Province, one additional CEmOC and four BEmOCs were installed and case fatality rates decreased. In conclusion, the strategy for ensuring provision of EmOC is feasible even in countries with minimal resources and a scarcity of physicians, such as Mozambique. [Copyright &y& Elsevier]

Objective: To compare the course and outcome of triplet gestations under a preventive care strategy that includes hospitalization, surveillance, bed rest, and daily specialized care from the beginning of the second trimester, with pregnancies managed according to the Croatian standard outpatient care protocol for multiplets. Methods: A retrospective study of 79 triplet pregnancies. Preventive hospitalization from the beginning of the second trimester, with complete bed rest and all necessary interventions, was chosen by 55 women (Group I). The remaining 24 women (Group II) elected the standard outpatient protocol for multiple pregnancies. Outpatient management with prophylactic bed rest was initiated at home as soon as the multiple pregnancy was diagnosed. After 28 weeks of gestation, all outpatients were hospitalized until delivery irrespective of symptoms. Results: There was no difference between the groups regarding maternal age, race, pre-pregnancy weight and height, weight gain during the first 24 weeks of pregnancy, or the proportion of pregnancies achieved with assisted reproductive technology. Four out of 55 women (7.2%) from Group I and 4 out of 24 women (12.5%) from Group II had monochorionic triplet pregnancies (P=n.s.). Nulliparity was more frequent in Group I than in Group II (P=0.006). Elective cesarean delivery was significantly more frequent in Group I (46 out of 55 gestations, 72.7%) than in Group II (9 out of 24 gestations, 37.5%), P=0.024. Gestational age at delivery and mean birth weight were significantly higher in Group I than in Group II (P<0.001). Deliveries up to 28 weeks of pregnancy were infrequent in Group I (P=0.02). Thirty-three gestations in Group I (60%) and 6 (25%) in Group II had a duration of 33–36 weeks (P<0.001). Two out of 55 triplet gestations in Group I (3.6%) and 4 out of 24 in Group II (16.7%) ended in spontaneous abortion (P=0.053). The survival of the three triplets was more frequent in Group I than in Group II (P=0.048). For gestations reaching 24 weeks or more, the fetal and perinatal death rate was significantly lower in Group I (P<0.001). In Group I the intrauterine death rate for fetuses weighing 1500 g or less was also significantly lower (P=0.007), and the early neonatal death rate was almost half (15.8 vs. 28.9%, P=0.157). There were no differences in other pregnancy complications between the two groups except significantly more frequent preterm premature rupture of membranes and preterm labor requiring parenteral tocolysis in Group II (P=0.042 and 0.036, respectively), and significantly more frequent fetal growth retardation in Group I (P<0.001). Conclusion: Preventive hospitalization offers a better outcome for triplets even though prolonged hospitalization and all other procedures necessary to achieve optimal pregnancy outcome are also offered in the Croatian standard outpatient care protocol for multiplet pregnancies. [Copyright &y& Elsevier]

Objectives: To determine the stillbirth rate and factors predisposing to a stillbirth delivery at a teaching hospital in Nigeria, with the aim of identifying solutions.Method: A descriptive study of all stillbirths delivered at Enugu State University of Science and Technology Teaching Hospital, Parklane, Nigeria between January 1 and December 31, 2009. The sociodemographic characteristics of the mothers were documented and the possible causes of death were analyzed.Results: There were 153 stillbirths and 2064 total deliveries, giving a stillbirth rate of 74 per 1000 deliveries. Of the stillbirths, 52.3% were fresh and 47.7% were macerated. Women who had not received prenatal care had a significantly higher stillbirth rate (P<0.05). The most likely cause of a macerated stillbirth was a hypertensive disorder of pregnancy, whereas the likely causes of fresh stillbirths were labor-related. The "3 levels of delay" and injudicious use of oxytocin in labor contributed to the intrapartum stillbirths (P<0.05).Conclusion: The stillbirth rate recorded in the study institution is unacceptably high. Appropriate prenatal care, timely intervention, and prompt and appropriate intrapartum care are key to achieving a reduction in the stillbirth rate. [ABSTRACT FROM AUTHOR]