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Objective: To describe the outcomes and quality of care for women and their babies after caesarean section (CS) in Nigerian referral‐level hospitals. Design: Secondary analysis of a nationwide cross‐sectional study. Setting: Fifty‐four referral‐level hospitals. Population: All women giving birth in the participating facilities between 1 September 2019 and 31 August 2020. Methods: Data for the women were extracted, including sociodemographic data, clinical information, mode of birth, and maternal and perinatal outcomes. A conceptual hierarchical framework was employed to explore the sociodemographic and clinical factors associated with maternal and perinatal death in women who had an emergency CS. Main Outcome Measures: Overall CS rate, outcomes for women who had CS, and factors associated with maternal and perinatal mortality. Results: The overall CS rate was 33.3% (22 838/68 640). The majority of CS deliveries were emergency cases (62.8%) and 8.1% of CS deliveries had complications after delivery, which were more common after an emergency CS. There were 179 (0.8%) maternal deaths in women who had a CS and 29.6% resulted from complications of hypertensive disorders of pregnancy. The overall maternal mortality rate in women who delivered by CS was 778 per 100 000 live births, whereas the perinatal mortality at birth was 51 per 1000 live births. Factors associated with maternal mortality in women who had an emergency CS were being <20 or >35 years of age, having a lower level of education and being referred from another facility or informal setting. Conclusions: One‐third of births were delivered via CS (mostly emergency), with almost one in ten women experiencing a complication after a CS. To improve outcomes, hospitals should invest in care and remove obstacles to accessible quality CS services. [ABSTRACT FROM AUTHOR]

The article discusses the establishment of the Maternal and Perinatal Database for Quality, Equity, and Dignity (MPD-4-QED) program in Nigeria, which aims to monitor the quality of maternal and newborn care in referral-level hospitals. The program collects data through an electronic platform and involves medical record officers and hospital coordinators. The article highlights implementation challenges, lessons learned, and future prospects. The document provides lists of hospitals, indicators, and definitions related to healthcare quality, as well as variables and descriptions for studying obstetrics and clinical conditions during pregnancy and labor. It also includes medical terms and definitions, and data elements for neonatal care, gynecological admissions, maternal death audits, and perinatal death audits. These resources are valuable for researchers studying healthcare in Nigeria and maternal and baby health. [Extracted from the article]

This article highlights the maternal health crisis in Nigeria and the urgent need for action to address it. Nigeria has a high maternal mortality rate and contributes significantly to global maternal and neonatal deaths. The Maternal and Perinatal Database for Quality, Equity, and Dignity Programme (MPD-4-QED) was established to analyze the quality and outcomes of care in Nigerian hospitals. The articles in this special issue of BJOG explore the challenges faced by expectant mothers and newborns in Nigeria and propose data-driven solutions. The authors emphasize the importance of collaboration and collective efforts to reduce maternal and perinatal deaths in Nigeria and achieve the Sustainable Development Goals. [Extracted from the article]

Introduction: Postpartum hemorrhage (PPH) remains the leading cause of maternal mortality. A new clinical intervention (E-MOTIVE) holds the potential to improve early PPH detection and management. We aimed to develop and pilot implementation strategies to support uptake of this intervention in Kenya, Nigeria, South Africa, and Tanzania., Methods: Implementation strategy development: We triangulated findings from qualitative interviews, surveys and a qualitative evidence synthesis to identify current PPH care practices and influences on future intervention implementation. We mapped influences using implementation science frameworks to identify candidate implementation strategies before presenting these at stakeholder consultation and design workshops to discuss feasibility, acceptability, and local adaptations. Piloting: The intervention and implementation strategies were piloted in 12 health facilities (3 per country) over 3 months. Interviews (n=58), case report forms (n=1,269), and direct observations (18 vaginal births, 7 PPHs) were used to assess feasibility, acceptability, and fidelity., Results: Implementation strategy development: Key influences included shortages of drugs, supplies, and staff, limited in-service training, and perceived benefits of the intervention (e.g., more accurate PPH detection and reduced PPH mortality). Proposed implementation strategies included a PPH trolley, on-site simulation-based training, champions, and audit and feedback. Country-specific adaptations included merging the E-MOTIVE intervention with national maternal health trainings, adapting local PPH protocols, and PPH trollies depending on staff needs. Piloting: Intervention and implementation strategy fidelity differed within and across countries. Calibrated drapes resulted in earlier and more accurate PPH detection but were not consistently used at the start. Implementation strategies were feasible to deliver; however, some instances of limited use were observed (e.g., PPH trolley and skills practice after training)., Conclusion: Systematic intervention development, piloting, and process evaluation helped identify initial challenges related to intervention fidelity, which were addressed ahead of a larger-scale effectiveness evaluation. This has helped maximize the internal validity of the trial., (© Forbes et al.)

Objective: To describe the outcomes and quality of care for women and their babies after caesarean section (CS) in Nigerian referral-level hospitals., Design: Secondary analysis of a nationwide cross-sectional study., Setting: Fifty-four referral-level hospitals., Population: All women giving birth in the participating facilities between 1 September 2019 and 31 August 2020., Methods: Data for the women were extracted, including sociodemographic data, clinical information, mode of birth, and maternal and perinatal outcomes. A conceptual hierarchical framework was employed to explore the sociodemographic and clinical factors associated with maternal and perinatal death in women who had an emergency CS., Main Outcome Measures: Overall CS rate, outcomes for women who had CS, and factors associated with maternal and perinatal mortality., Results: The overall CS rate was 33.3% (22 838/68 640). The majority of CS deliveries were emergency cases (62.8%) and 8.1% of CS deliveries had complications after delivery, which were more common after an emergency CS. There were 179 (0.8%) maternal deaths in women who had a CS and 29.6% resulted from complications of hypertensive disorders of pregnancy. The overall maternal mortality rate in women who delivered by CS was 778 per 100 000 live births, whereas the perinatal mortality at birth was 51 per 1000 live births. Factors associated with maternal mortality in women who had an emergency CS were being <20 or >35 years of age, having a lower level of education and being referred from another facility or informal setting., Conclusions: One-third of births were delivered via CS (mostly emergency), with almost one in ten women experiencing a complication after a CS. To improve outcomes, hospitals should invest in care and remove obstacles to accessible quality CS services., (© 2024 John Wiley & Sons Ltd.)

Objective: To determine the prevalence of primary postpartum haemorrhage (PPH), risk factors, and maternal and neonatal outcomes in a multicentre study across Nigeria., Design: A secondary data analysis using a cross-sectional design., Setting: Referral-level hospitals (48 public and six private facilities)., Population: Women admitted for birth between 1 September 2019 and 31 August 2020., Methods: Data collected over a 1-year period from the Maternal and Perinatal Database for Quality, Equity and Dignity programme in Nigeria were analysed, stratified by mode of delivery (vaginal or caesarean), using a mixed-effects logistic regression model., Main Outcome Measures: Prevalence of PPH and maternal and neonatal outcomes., Results: Of 68 754 women, 2169 (3.2%, 95% CI 3.07%-3.30%) had PPH, with a prevalence of 2.7% (95% CI 2.55%-2.85%) and 4.0% (95% CI 3.75%-4.25%) for vaginal and caesarean deliveries, respectively. Factors associated with PPH following vaginal delivery were: no formal education (aOR 2.2, 95% CI 1.8-2.6, P < 0.001); multiple pregnancy (aOR 2.7, 95% CI 2.1-3.5, P < 0.001); and antepartum haemorrhage (aOR 11.7, 95% CI 9.4-14.7, P < 0.001). Factors associated with PPH in a caesarean delivery were: maternal age of >35 years (aOR 1.7, 95% CI 1.5-2.0, P < 0.001); referral from informal setting (aOR 2.4, 95% CI 1.4-4.0, P = 0.002); and antepartum haemorrhage (aOR 3.7, 95% CI 2.8-4.7, P < 0.001). Maternal mortality occurred in 4.8% (104/2169) of deliveries overall, and in 8.5% (101/1182) of intensive care unit admissions. One-quarter of all infants were stillborn (570/2307), representing 23.9% (429/1796) of neonatal intensive care unit admissions., Conclusions: A PPH prevalence of 3.2% can be reduced with improved access to skilled birth attendants., (© 2024 John Wiley & Sons Ltd.)

Objective: To assess the effects of COVID-19 vaccines in women before or during pregnancy on SARS-CoV-2 infection-related, pregnancy, offspring and reactogenicity outcomes., Design: Systematic review and meta-analysis., Data Sources: Major databases between December 2019 and January 2023., Study Selection: Nine pairs of reviewers contributed to study selection. We included test-negative designs, comparative cohorts and randomised trials on effects of COVID-19 vaccines on infection-related and pregnancy outcomes. Non-comparative cohort studies reporting reactogenicity outcomes were also included., Quality Assessment, Data Extraction and Analysis: Two reviewers independently assessed study quality and extracted data. We undertook random-effects meta-analysis and reported findings as HRs, risk ratios (RRs), ORs or rates with 95% CIs., Results: Sixty-seven studies (1 813 947 women) were included. Overall, in test-negative design studies, pregnant women fully vaccinated with any COVID-19 vaccine had 61% reduced odds of SARS-CoV-2 infection during pregnancy (OR 0.39, 95% CI 0.21 to 0.75; 4 studies, 23 927 women; I 2 =87.2%) and 94% reduced odds of hospital admission (OR 0.06, 95% CI 0.01 to 0.71; 2 studies, 868 women; I 2 =92%). In adjusted cohort studies, the risk of hypertensive disorders in pregnancy was reduced by 12% (RR 0.88, 95% CI 0.82 to 0.92; 2 studies; 115 085 women), while caesarean section was reduced by 9% (OR 0.91, 95% CI 0.85 to 0.98; 6 studies; 30 192 women). We observed an 8% reduction in the risk of neonatal intensive care unit admission (RR 0.92, 95% CI 0.87 to 0.97; 2 studies; 54 569 women) in babies born to vaccinated versus not vaccinated women. In general, vaccination during pregnancy was not associated with increased risk of adverse pregnancy or perinatal outcomes. Pain at the injection site was the most common side effect reported (77%, 95% CI 52% to 94%; 11 studies; 27 195 women)., Conclusion: COVID-19 vaccines are effective in preventing SARS-CoV-2 infection and related complications in pregnant women., Prospero Registration Number: CRD42020178076., Competing Interests: Competing interests: None declared., (© World Health Organization 2024. Licensee BMJ.)