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Background: Research has shown caseload midwifery to increase the chance of vaginal birth, but this may not be the case in settings with high vaginal birth rates in standard care. This study investigated the association between caseload midwifery and birth mode, labor interventions, and maternal and neonatal outcomes at a large obstetric unit in Denmark. Methods: Cohort study including medical records on live, singleton births fr om June 2018 until February 2022. Exposure was caseload midwifery care compared with standard midwifery care. The primary outcome was birth mode, and secondary outcomes were other outcomes of labor. Adjusted risk ratios (aRR) with 95% confidence intervals (CI) were estimated by log‐binomial regression. Results: Among 16,110 pregnancies, 3162 pregnancies (19.6%) received caseload midwifery care. Caseload midwifery was associated with fewer planned cesareans (aRR 0.63 [95% CI 0.54–0.74]) and emergency cesareans (aRR 0.86 [95% CI 0.75–0.95]). No differences in labor induction, use of epidural analgesia, oxytocin augmentation, or anal sphincter tears were observed. Caseload midwifery performed more amniotomies (aRR 1.14 [95% CI 1.02–1.27]) and tended to perform more episiotomies (aRR 1.19 [95% CI 0.96–1.48]). Postpartum hemorrhage (aRR 0.90 [95% CI 0.82–0.99]) and low Apgar score were less likely (aRR 0.54 [95% CI 0.37–0.77]), and early discharge more likely (aRR 1.22 [95% CI 1.17–1.28]) in caseload midwifery. Conclusion: In caseload midwifery care, a higher vaginal birth rate was observed with no increase in adverse outcomes, mainly due to a lower likelihood of planned cesarean. Also, fewer children were born with low Apgar scores. [ABSTRACT FROM AUTHOR]

Background: Shoulder dystocia is an unpredictable obstetric condition with potential long‐term neonatal complications. The risk of neonatal injury might be related to the condition itself as well as to the obstetrics maneuvers used for its release. Objectives: To examine the available evidence to assess current management and possible improvement of outcomes. Search Strategy: A comprehensive search of MEDLINE, EMBASE, EMCARE, and The Cochrane Library database was performed, all studies reporting on neonatal outcomes in cases of shoulder dystocia stratified by obstetric maneuvers used for delivery were included. Data abstraction was performed and checked by two independent reviewers. Results: McRoberts maneuver was the least associated with risk of neonatal injury (odds ratio 0.6, 95% confidence interval 0.4–0.9), followed by delivery of posterior arm. Conclusion: Delivery of posterior arm might be prioritized in cases of shoulder dystocia after failed McRoberts. Neonatal hypoxic injury correlates with the duration of dystocia rather than the maneuver used. Synopsis: Neonatal injury in shoulder dystocia can be mechanical or metabolic, but hypoxic injury seems more related to duration than the maneuver used for release. [ABSTRACT FROM AUTHOR]

Background: Healthcare practice environment plays a vital role in evaluation and the development of health sector in China. However, there are few comprehensive reviews and studies focusing on its state and changing trends. This study aimed to examine the dynamic trends in Chinese healthcare professionals' perceptions of their practice environment from 2008 to 2023 using age period cohort (APC) analysis. Methods: Four national cross-sectional surveys of healthcare professionals were conducted in 2008, 2013, 2018, and 2023. APC analysis was performed to distinguish effects of age, period and cohort. Covariates like gender, department, job satisfaction, and doctor–patient relationships were also analyzed. Results: Between 2008 and 2023, healthcare professionals' perceptions of their practice environment first declined and then improved. Those aged 28–38 during 2013–2018 and born between 1978 and 1988 had the most negative perceptions. After 2018, perceptions improved, peaking in 2023. Those under 23 and over 43 exhibited larger age effects. Birth cohorts after 1993 also had more positive effects. Controlling for covariates attenuated APC effects. Females, those in obstetrics and emergency medicine, nurses, technicians, and administrators perceived better environments. Higher job satisfaction and doctor–patient relationship harmony are also associated with more positive perceptions. Income matching efforts and perceptions of promotion fairness had positive impacts, while increasing severity of physical fatigue and psychological anxiety negatively influenced perceptions of the practice environment. Conclusions: The APC analysis provided nuanced insights into evolving practitioner perceptions amid healthcare reforms in China. Tailored policies focused on career stage and generation are needed to address disruptions and sustain improvements. Monitoring feedback on reforms and changes is essential for optimizing the practice environment over time. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective Design Setting Sample Methods Results Conclusions To understand the experiences of women, birth partners and health professionals of verbal followed by retrospective written consent in a prospective cohort study of a device to manage postpartum haemorrhage (PPH).Grounded Theory.Tertiary facility in North‐West England, UK.We used purposive and theoretical sampling to recruit 51 participants; 12 women, 12 birth partners, 16 obstetricians and 11 midwives.Semi‐structured interviews were conducted, using a topic guide for focus, until data saturation was achieved. Data were analysed using framework analysis technique.Most women wanted sufficient information to make a decision at the time of the event, rather than in advance, and preferred not to be overwhelmed with detail. A key factor in making the decision to participate was a positive and trusting relationship with the attending obstetrician. Obtaining consent for research in emergencies was viewed by obstetricians as requiring a different approach and more challenging than consent for standard procedures in an emergency.This is one of the first studies to explore verbal followed by retrospective written consent processes with women, clinicians and observers. This was acceptable to all, however information needs to be appropriate, and those discussing consent require adequate training (199/200). [ABSTRACT FROM AUTHOR]

Background: High rates of adverse neonatal outcomes in resource-limited settings are multifactorial, varying by country, region, and institution. In sub-Saharan Africa, the majority of adverse neonatal outcomes are intrapartum related, and studies in Uganda have shown that referral in labor is a major determinant of adverse neonatal outcomes. This study aimed to assess the incidence and factors associated with immediate adverse neonatal outcomes among emergency obstetric referrals in labor at a tertiary hospital in Eastern Uganda. Materials and methods: This was a prospective cohort study involving 265 women who were referred in labor to Jinja Regional Referral Hospital in Uganda with emergency obstetric complications. The exposure of interest was being referred with obstetrical emergency, and the outcome variable was adverse neonatal outcomes. The study was conducted between July 5, 2023, and October 5, 2023. Consecutive sampling was used, and data on sociodemographic and obstetric factors, referral related factors, as well as the primary outcome variable (adverse neonatal outcome) were collected via interviewer-administered questionnaires. The data were then cleaned, coded, and analyzed using STATA version 14. Log-binomial regression determined risk ratios and associations for factors related to adverse neonatal outcomes. Variables with p-values < 0.2 in bivariable analysis were included in the multivariable analysis, where significance was set at p < 0.05. Results: Of the 265 women exposed to emergency obstetrical referrals, 40% experienced adverse neonatal outcomes, a composite measure including neonatal intensive care admission (27.6%), low Apgar score (23.8%), fresh stillbirth (11.3%), early-onset neonatal infection (6.8%), and early neonatal death (2.3%). Factors significantly associated with adverse neonatal outcomes were; maternal age ≥ 35 years (aRR = 1.72, CI:1.194–2.477, p value = 0.004), APH (aRR = 2.48, CI: 1.859–3.311, p-value < 0.001), and non-reassuring fetal status (aRR = 1.90, CI: 1.394–2.584, p-value < 0.001). Conclusions: The study found a high rate of adverse neonatal outcomes among emergency obstetric referrals, with 40% of participants facing issues like ICU admissions, low Apgar scores and fresh stillbirth. Key factors included maternal age over 35, antepartum hemorrhage, and non-reassuring fetal status. These results highlight the urgent need for targeted interventions in emergency obstetric care. Strategies should enhance referral systems, improve facility preparedness, train healthcare providers, and educate communities on timely referrals and managing high-risk pregnancies. [ABSTRACT FROM AUTHOR]

Background: Ensuring healthcare services are equipped to offer; emergency obstetric and newborn care (EmONC) is crucial for improving the quality of maternal and newborn care in low- and middle-income countries. We assessed the temporal trends of the availability and readiness of the healthcare system to provide EmONC in Burkina Faso. Methods: We analyzed the data from three national health facilities surveys, conducted in 2014, 2016 and 2018, using the WHO Service Availability and Readiness Assessment tool. We performed multivariable linear regression models to examine the trends. Results: Between 2014 and 2018, the percentage of healthcare facilities providing delivery service and blood transfusion significantly decreased (88.1% to 75.4% for delivery services and 67.3% to 50.2% for blood transfusion, p < 0.001). The readiness index of healthcare facilities to provide basic EmONC showed a negative trend according to public healthcare, primary healthcare, and Centre-Nord, Centre-sud, Hauts-Bassins, Nord, Plateau Central and Sud-ouest health regions. Conclusions: We observed multiple indications of a decline in the readiness of healthcare services to offer EmONC in Burkina Faso from 2014 to 2018. As such, bolstering the capabilities of health facilities to deliver EmONC is essential for hastening the decrease in maternal mortality. [ABSTRACT FROM AUTHOR]

Background Objectives Search Strategy Selection Criteria Data Collection and Analysis Main Results and Conclusions Prostaglandins (PGs) have emerged as key drugs in second trimester medical abortion (STMA) and are currently a cornerstone in obstetric practice. Nevertheless, the application of PGs, integral to labor and abortion procedures, is not risk‐free, and has been associated with several complications, particularly maternal fever and uterine rupture (UR).The main outcome of the present systematic review was to assess the safety of PGs use in STMA, particularly in scarred uterus (SC).The review adhered to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guideline. We performed a comprehensive systematic review by searching multiple databases, including MEDLINE, EMBASE, Global Health, The Cochrane Library, Health Technology Assessment Database, and the research registers of Web of Science during the years 1990–2022.Only articles regarding cases of UR occurred after the use of PGs for STMA were included in the article. We excluded papers regarding UR during first trimester abortion induction of labor or pregnancy or unrelated to PGs use for STMA. Risk of bias was assessed employing a modified version of the “Newcastle‐Ottawa Scale” (NOS).A total of 178 studies were initially identified as potentially meeting the criteria for inclusion in the review. After full text evaluation, 110 other articles were excluded and 67 studies that suited the inclusion criteria were included. A total of 19 of the included studies were judged to have a high risk of bias. Given the heterogeneous nature of the findings, we opted for a narrative synthesis of the results.PGs appear to be an effective pharmacologic tool for STMA; however, their use is not entirely risk‐free. STMA requires well‐equipped obstetric centers with skilled clinicians and surgeons prepared for emergencies. Ultrasonographic scans should be routinely performed during STMA management, since a UR can also be silent during the induction of labor. Intrapartum transabdominal, transperineal, and transvaginal ultrasound may have the diagnostic potential to early recognize this obstetric emergency, to facilitate rapid medical and surgical treatment, improving the outcome. [ABSTRACT FROM AUTHOR]

The Special Issue on Digital Health commemorates the 40th Anniversary of the Takemi Program in International Health at Harvard University, examining the potential and obstacles of digital health. The articles investigate the influence of digital technologies on health systems worldwide, with a specific focus on low- and middle-income countries. Various topics are explored, such as internet-based health information access, digitally supported health workers, healthcare delivery at home, transportation and logistics management innovations, and utilizing data to enhance health system performance. The papers present detailed case studies, evaluations, and frameworks for comprehending and planning digital health interventions, including studies on chronic disease management in rural South Korea, addressing gender-based violence in rural Nigeria, analyzing the Maharashtra ambulance service in India, and discussing digital transformation in the health product supply chain. Additionally, the text examines the role of digital health within Taiwan's national health insurance system and the utilization of digital health data for Palestine refugees, shedding light on the readiness, obstacles, and possibilities for integrating digital technology into healthcare systems across diverse regions. [Extracted from the article]

Introduction: Shoulder dystocia is a severe obstetric emergency that can cause substantial neonatal and maternal complications. This study aims to assess the performed obstetric maneuvers and their frequency, success, and association with maternal and neonatal complication rates. Material and methods: The study population was collected among all deliveries in the Hospital District of Helsinki and Uusimaa between 2006 and 2015 (n = 181 352) by searching for ICD‐10 codes for shoulder dystocia, brachial plexus injury and clavicle fracture. Shoulder dystocia cases (n = 537) were identified by reviewing the medical records. Shoulder dystocia cases treated with one or two maneuvers were compared with those treated with at least three. Medical records of a matched control group constituting of 566 parturients without any of the forementioned ICD‐10 codes were also scrutinized. Results: Using the four most common obstetric maneuvers (McRoberts maneuver, suprapubic pressure, rotational maneuvers, the delivery of the posterior arm) significantly increased during the study period with individual success rates of 61.0%, 71.9%, 68.1% and 84.8%, respectively. Concurrently, the rate of brachial plexus injury and combined neonatal morbidity significantly declined from 50% to 24.2% (p = 0.02) and from 91.4% to 48.5% (p < 0.001). Approximately 75% of shoulder dystocia cases treated with maneuvers were resolved by the McRoberts maneuver and/or suprapubic pressure, but each of the four most performed maneuvers significantly increased the cumulative success rate individually and statistically (p < 0.001). The rates of brachial plexus injury and combined neonatal morbidity were at their highest (52.9% and 97.8%) when none of the maneuvers were performed and at their lowest when two maneuvers were performed (43.0% and 65.4%). The increasing number (≥3) of maneuvers did not affect the combined maternal or neonatal morbidity or brachial plexus injury but increased the risk for third‐ or fourth‐degree lacerations (odds ratio 2.91, 95% confidence interval 1.17 to 7.24). Conclusions: The increased use of obstetric maneuvers during the study period was associated with decreasing rates of neonatal complications; conversely, the lack of obstetric maneuvers was associated with the highest rate of neonatal complications. These emphasize the importance of education, maneuver training and urgently performing shoulder dystocia maneuvers according to the international protocol guidelines. [ABSTRACT FROM AUTHOR]

Objective: To assess factors impacting obstetric transport and referral processes for pregnant patients experiencing an emergency in a rural state without a perinatal regionalized system of care. Data Sources and Study Setting: Data is from Critical Access Hospitals (CAHs) without obstetric units and healthcare providers involved in obstetric care and transport at hospitals with varying levels of obstetric capacity in Montana. Study Design: This mixed‐methods study involved surveying CAHs without obstetric units about the hospitals' capacity for obstetric emergencies and transport policies. Survey data were collected from 32 of 34 CAHs without obstetric units (94% response rate) in the fall of 2021. Subsequent interviews were conducted in the fall and winter of 2022–2023 with 20 hospital and emergency medical services (EMS) personnel to provide further insights into the referral and transport process during obstetric emergencies. Data Collection/Extraction Methods: Survey data were collected using REDCap; interviews were conducted via videoconference. We performed descriptive statistics and Fisher's exact tests for quantitative data. We analyzed qualitative data using a three‐phase pragmatic analytic approach. Principal Findings: The survey of CAHs found 12 of 32 facilities faced difficulties coordinating transport for pregnant patients. Qualitative data indicated this was often due to the state's decentralized transport system. Challenges identified through both quantitative and qualitative data included weather, securing a receiving facility/provider, and coordinating medical transport. Only 10 CAHs reported having written protocols for transporting pregnant patients; of those, four facilities had formal transfer agreements. Qualitative data emphasized variations in awareness and the utility of obstetric transport policies. Conclusions: A decentralized transport system in a rural state can exacerbate existing challenges faced by providers arranging transport for pregnant patients during an obstetric emergency. State and interfacility policies could enhance the transport process for increased regionalization as well as increased support for and coordination of existing EMS. [ABSTRACT FROM AUTHOR]

Background: Prehospital obstetric events, including out-of-hospital deliveries and their complications, are a rare but high-risk event encountered by emergency medical services (EMS). Understanding the epidemiology of these encounters would help identify strategies to improve prehospital obstetric care. Our objective was to determine the characteristics of out-of-hospital deliveries and high-risk complications treated by EMS clinicians in the U.S. Methods: We conducted a cross-sectional analysis of EMS patient care records in the 2018 and 2019 National EMS Information System Public Release Version 3.4 datasets. We included EMS activations after a 9-1-1 scene response for patients aged 12–50 years with evidence of an out-of-hospital delivery or delivery complication, or where the patient was a newborn aged 0-<6 h. We examined patient, community, emergency response, and clinical characteristics using descriptive statistics. Results: Of the 56,735,977 EMS activations included in the 2018 and 2019 datasets, there were 8,614 out-of-hospital deliveries, 1,712 delivery complications, and 5,749 records for newborns. Most maternal (76%) out-of-hospital deliveries involved patients between the ages of 20–34 years, occurred on a weekday (73%), were treated by an advanced life support crew (85%), and occurred in a home or residence (73%). EMS-assisted field delivery was documented in 3,515 (34%) of all maternal activations but only 2% of activations with a delivery complication. Few patients received an EMS-administered medication (e.g., 0.4% received oxytocin). Supplemental oxygen was administered in 870 (15%) of newborn activations. Activations from counties with the most racial/ethnic diversity were more often treated by a BLS-level unit (16% vs. 12%, p < 0.001), and activations from rural areas had significantly longer transport times (19.7 min [IQR 8.7, 32.8] vs. urban, 13.1 min [IQR 8.7, 19.7], p < 0.001). Conclusion: In this large, national repository of EMS patient care records from across the U.S., most activations for out-of-hospital delivery, delivery complication, or a newborn included only routine EMS care. There were potential disparities in level of care, clinical care provided, and measures of access to definitive care based on maternal and community factors. We also identified gaps in current practice, such as for postpartum hemorrhage, that could be addressed with changes in EMS clinical protocols and regulations. [ABSTRACT FROM AUTHOR]

Background and Aims: Obstetric fistula is a severe birth injury that profoundly impacts women's health, social well‐being, economic stability, and psychological state. While it can be prevented with timely emergency obstetric care, a significant barrier in many developing regions, including the study area, is the lack of awareness among women. This study aimed to evaluate the level of awareness about obstetric fistula and the factors influencing it among the Women Health Development Army in the South Gondar zone of the Amhara region, Ethiopia, in 2020. Methods: A community‐based cross‐sectional study was done from July to December 2020, involving 633 women. Participants were selected using a multistage stratified sampling method. Data were collected using a pretested, interviewer‐administered structured questionnaire. Data entry was performed using EpiData version 3.1, and analysis was conducted with SPSS version 23.0. Multivariable logistic regression models were employed to identify influencing factors, with a p < 0.05 considered statistically significant. Results: This study found that 55.3% (95% CI, 51.6%–57.2%) of study participants had a good awareness of obstetrics fistula. Significantly associated factors include; no history of ANC (AOR = 0.52: 95% CI, 0.31, 0.86), living >30 min away from a health facility (AOR = 0.43: 95% CI, 0.23, 0.81), no history of abortion (AOR = 0.37: 95% CI, 0.19, 0.72), Injectable and implant users (AOR = 3.60: 95% CI, 1.98, 6.53), having four to six pregnancy (AOR = 1.87: 95% CI, 1.22, 2.87) and lack of communication material in the house (AOR = 0.19: 95% CI, 0.10, 0.37). Conclusions: This study found that 55.3% of women have a good awareness of obstetrics fistula. ANC follow‐up history, abortion history, type of family planning, type of communication, number of pregnancies, availability of health facility, and distance of health facility were significantly associated with awareness of obstetric fistula. Hence, local and national efforts should be made to enhance access to information at home and basic maternal health services including antenatal care. [ABSTRACT FROM AUTHOR]

Background and Objectives: Intra/postpartum hemorrhage stands as a significant obstetric emergency, ranking among the top five leading causes of maternal mortality. The aim of this study was to assess the predictive performance of four machine learning algorithms for the prediction of postpartum and intrapartum hemorrhage. Materials and Methods: A prospective multicenter study was conducted, involving 203 patients with or without intra/postpartum hemorrhage within the initial 24 h postpartum. The participants were categorized into two groups: those with intra/postpartum hemorrhage (PPH) and those without PPH (control group). The PPH group was further stratified into four classes following the Advanced Trauma Life Support guidelines. Clinical data collected from these patients was included in four machine learning-based algorithms whose predictive performance was assessed. Results: The Naïve Bayes (NB) algorithm exhibited the highest accuracy in predicting PPH, boasting a sensitivity of 96.3% and an accuracy of 98.6%, with a false negative rate of 3.7%. Following closely were the Decision Tree (DT) and Random Forest (RF) algorithms, each achieving sensitivities exceeding 94% with a false negative rate of 5.9%. Regarding severity classification I, the NB and Support Vector Machine (SVM) algorithms demonstrated superior predictive capabilities, achieving a sensitivity of 96.4%, an accuracy of 92.1%, and a false negative rate of 3.6%. The most severe manifestations of HPP were most accurately predicted by the NB algorithm, with a sensitivity of 89.3%, an accuracy of 82.4%, and a false negative rate of 10.7%. Conclusions: The NB algorithm demonstrated the highest accuracy in predicting PPH. A notable discrepancy in algorithm performance was observed between mild and severe forms, with the NB and SVM algorithms displaying superior sensitivity and lower rates of false negatives, particularly for mild forms. [ABSTRACT FROM AUTHOR]

Background: Antepartum hemorrhage (APH) is an obstetric emergency that complicates pregnancy worldwide and continues to lead to hemorrhagic conditions in parts of Tanzania. Midwifery education received by midwives consists theoretical knowledge on the subject but with no or minimal practical skills in the laboratory, which may reduce their practical capacity as graduated midwives. This study therefore aimed to explore midwives' clinical actions and experiences regarding the care of women with APH in Mwanza region. Method: Qualitative, inductive approach with critical incident technique was used. Data were analysed using the critical incident technique, and a question guide consisting of eleven open-ended questions was used to collect data from 44 out of 60 midwives who graduated not less than one year. A total of 522 critical incidents, with 199 actions and 323 experiences, were identified and categorized into five main areas. Ethical approval was obtained. Results: Midwives' clinical actions and experiences in caring for women with APH are affected by the knowledge and skills obtained during training at school. They have insufficient theoretical knowledge and practical skills, leading to inadequate identification of the problem and the implementation of care. A need for additional preventive care is described and structural issues, such as co-operation, referral to other instances, access to equipment and relevant treatments need to be improved. Conclusion: The actions taken to provide care for women with APH were related to their ability to identify problems, implement care and carry out structural initiatives. However, the midwives' experience was influenced by an attempt to understand the seriousness of the situation and the existence of an organizational challenge. The results can provide knowledge and tools to improve midwives' education and clinical practice and in the long run, prevent complications, improves health and minimize suffering in women with APH. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective Design Setting Population Methods Main Outcome Measures Results Conclusions To determine the change in English emergency postnatal maternal readmissions 2007–2017 (pre‐COVID‐19) and the association with maternal demographics, obstetric risk factors and postnatal length of stay (LOS).National cohort study.All English National Health Service hospitals.A total of 6 192 140 women who gave birth in English NHS hospitals from April 2007 to March 2017.Statistical analysis using birth and readmission data from routinely collected National Hospital Episode Statistics (HES) database.Rate of emergency postnatal maternal hospital readmissions related to pregnancy or giving birth within 42 days postpartum, readmission diagnoses and association with maternal demographic factors, obstetric risk factors and postnatal LOS.A significant increase in the rate of emergency postnatal maternal readmissions from 15 128 (2.5%) in 2008 to 20 734 (3.4%) in 2016 (aOR 1.32, 95% CI 1.28–1.37) was found. Risk factors for readmission included minoritised ethnicity (particularly Black or Black British ethnicity: aOR 1.35, 95% CI 1.31–1.39); age < 20 years (aOR 1.09, 95% CI 1.05–1.12); 40+ years (aOR 1.07, 95% CI 1.03–1.10); primiparity (multiparity: aOR 0.92, 95% CI 0.91–0.93); nonspontaneous vaginal birth modes (emergency caesarean: aOR 1.86, 95% CI 1.82–1.90); longer LOS (4+ vs. 0 days: aOR 1.58, 95% CI 1.53–1.64); and obstetric risk factors including urinary retention (aOR 2.34, 95% CI 2.06–2.53) and postnatal wound breakdown (aOR 2.01, 95% CI 1.83–2.21).The concerning rise in emergency maternal readmissions should be addressed from a health inequalities perspective focusing on women from minoritised ethnic groups; those <20 and ≥40 years old; primiparous women; and those with specified obstetric risk factors. [ABSTRACT FROM AUTHOR]

Aims: This study aimed to evaluate the long‐term results of Japan Maternal Emergency Life‐Saving (J‐MELS) simulation training on obstetric healthcare providers, over a 12‐month follow‐up period. Methods: A total of 273 trainees from 17 J‐MELS Basic courses conducted between August 2021 and October 2023 were included. The trainees' responses to the pre‐ and post‐tests, questionnaires, and self‐reports on the usefulness of the J‐MELS scenarios in actual clinical settings at 1, 6, and 12 months after the training were analyzed. Multivariate logistic regression analysis was also conducted to identify the factors influencing knowledge retention. Results: We found an overall improvement in clinical knowledge acquisition after J‐MELS training and a significant retention of this improvement at least until 12 months later. However, these scores gradually declined over. Trainees reported increased usefulness of J‐MELS scenarios in actual clinical practice at 1, 6, and 12 months after training, particularly in managing obstetric emergencies such as atonic postpartum hemorrhage. Knowledge retention was influenced by several specific factors, such as years of clinical experience, affiliated institutions, qualifications, and especially pre‐test scores. Conclusion: Our longitudinal follow‐up study demonstrated, for the first time, the long‐term results of J‐MELS simulation training using post‐tests and self‐report data. Our findings provide valuable insight into the impact of J‐MELS simulation training on maternal emergency care. By elucidating the factors influencing knowledge retention and practical utility, the findings offer actionable recommendations for optimizing training strategies and improving maternal outcomes in actual clinical practice. [ABSTRACT FROM AUTHOR]

Introduction: Comadronas attend most births in rural and urban Guatemala where the maternal mortality rate (MMR) is highest in Latin America. Information has been published regarding rural comadronas' response to obstetrical emergencies. Understanding urban comadronas' response to obstetrical emergencies is essential to addressing Guatemala's MMR. Methods: A total of 17 urban comadronas participated in one, 34-min focus group to share their knowledge, practices, and attitudes regarding obstetrical emergencies. We used the long table to analyze the content to develop a matrix of themes. Results: Five themes emerged. Urban comadronas receive consistent training, have hospital transportation, and feel confident in their knowledge, but they lack equipment and feel hospital providers disrespect them. Still, the joy of attending births outweighs the challenges they face. Discussion: Urban comadronas described a different experience of responding to obstetrical emergencies than rural comadronas. Distinct approaches are needed to provide culturally congruent support for urban and rural comadronas when responding to obstetrical emergencies. [ABSTRACT FROM AUTHOR]

Objective: The optimal management of placenta accreta spectrum (PAS) requires the participation of multidisciplinary teams that are often not locally available in low‐resource settings. Telehealth has been increasingly used to manage complex obstetric conditions. Few studies have explored the use of telehealth for PAS management, and we aimed evaluate the usage of telehealth in the management of PAS patients in low‐resource settings. Methods: Between March and April 2023, an observational, survey‐based study was conducted, and obstetricians‐gynecologists with expertise in PAS management in low‐ and middle‐income countries were contacted to share their opinion on the potential use of telehealth for the diagnosis and management of patients at high‐risk of PAS at birth. Participants were identified based on their authorship of at least one published clinical study on PAS in the last 5 years and contacted by email. This is a secondary analysis of the results of that survey. Results: From 158 authors contacted we obtained 65 responses from participants in 27 middle‐income countries. A third of the participants reported the use of telehealth during the management obstetric emergencies (38.5%, n = 25) and PAS (36.9%, n = 24). Over 70% of those surveyed indicated that they had used "informal" telemedicine (phone call, email, or text message) during PAS management. Fifty‐nine participants (90.8%) reported that recommendations given remotely by expert colleagues were useful for management of patients with PAS in their setting. Conclusion: Telehealth has been successfully used for the management of PAS in middle‐income countries, and our survey indicates that it could support the development of specialist care in other low resource settings. Synopsis: Most obstetricians who provide care for patients with placenta accreta spectrum in low resource settings consider telemedicine useful for management of this complex condition. [ABSTRACT FROM AUTHOR]

Introduction: To achieve quality midwifery education, understanding the experiences of midwifery educators and students in implementing a competency-based pre-service curriculum is critical. This study explored the experiences of and barriers to implementing a pre-service curriculum updated with emergency obstetric and newborn care (EmONC) skills by midwifery educators, students and mentors in Kenya. Methods: This was a nested qualitative study within the cluster randomised controlled trial investigating the effectiveness of an EmONC enhanced midwifery curriculum delivered by trained and mentored midwifery educators on the quality of education and student performance in 20 colleges in Kenya. Following the pre-service midwifery curriculum EmONC update, capacity strengthening of educators through training (in both study arms) and additional mentoring of intervention-arm educators was undertaken. Focus group discussions were used to explore the experiences of and barriers to implementing the EmONC-enhanced curriculum by 20 educators and eight mentors. Debrief/feedback sessions with 6–9 students from each of the 20 colleges were conducted and field notes were taken. Data were analysed thematically using Braun and Clarke's six step criteria. Results: Themes identified related to experiences were: (i) relevancy of updated EmONC-enhanced curriculum to improve practice, (ii) training and mentoring valued as continuous professional development opportunities for midwifery educators, (iii) effective teaching and learning strategies acquired – peer teaching (teacher-teacher and student-student), simulation/scenario teaching and effective feedback techniques for effective learning and, (iv) effective collaborations between school/academic institution and hospital/clinical staff promoted effective training/learning. Barriers identified were (i) midwifery faculty shortage and heavy workload vs. high student population, (ii) infrastructure gaps in simulation teaching – inadequate space for simulation and lack of equipment inventory audits for replenishment (iii) inadequate clinical support for students due to inadequate clinical sites for experience, ineffective supervision and mentoring support, lack/shortage of clinical mentors and untrained hospital/clinical staff in EmONC and (iv) limited resources to support effective learning. Conclusion: Findings reveal an overwhelmed midwifery faculty and an urgent demand for students support in clinical settings to acquire EmONC competencies for enhanced practice. For quality midwifery education, adequate resources and regulatory/policy directives are needed in midwifery faculty staffing and development. A continuous professional development specific for educators is needed for effective student teaching and learning of a competency-based pre-service curriculum. [ABSTRACT FROM AUTHOR]

Provider adherence to the integrated antenatal care (ANC) procedure is an important indicator of high-quality ANC. The procedure is intended to avoid missed opportunities to detect the risk of abnormalities in pregnancy. This study aims to assess the provider's adherence to integrated ANC in Basic Emergency Obstetric and Newborn Care (BEmONC) and non-BEmONC Primary Health Center (PHC). This study employed an explanatory sequential mixed-method design. The quantitative phase reviewed 149 medical records of pregnant women in the four PHCs in Semarang from January until February 2020. The findings were used to describe the provider's adherence to the integrated ANC and lead to the contributing factors which should be explored in the qualitative phase. The study involved four in-depth interviews with midwife coordinators in four PHCs. The Mann-Whitney and Chi-square test was employed to analyse the quantitative data, while the thematic analysis was undertaken on the qualitative data. The provider's adherence to the guideline did not differ between BEmONC and non-BEmONC PHC. The general physical examination of the patients (18.81%) and dentist visits (84.6%) were not done in either BEmONC or non-BEmONC PHC. Incomplete laboratory tests were haemoglobin (28.2%) and urine protein (38.9%). The barriers to adherence to the integrated ANC guideline were related to an imbalance of resources, role and responsibility issues among doctors and midwives, and policy issues. This study found low BEmONC nor non-BEmONC PHC adherence to the integrated ANC guideline. A Periodic evaluation of the implementation of integrated ANC to ensure its high-quality implementation in Indonesia is needed. [ABSTRACT FROM AUTHOR]

Background: Routine health facility data are an important source of health information in resource-limited settings. Regular quality assessments are necessary to improve the reliability of routine data for different purposes, including estimating facility-based maternal mortality. This study aimed to assess the quality of routine data on deliveries, livebirths and maternal deaths in Kampala City, Uganda. Methods: We reviewed routine health facility data from the district health information system (DHIS2) for 2016 to 2021. This time period included an upgrade of DHIS2, resulting in two datasets (2016–2019 and 2020–2021) that were managed separately. We analysed data for all facilities that reported at least one delivery in any of the six years, and for a subset of facilities designated to provide emergency obstetric care (EmOC). We adapted the World Health Organization data quality review framework to assess completeness and internal consistency of the three data elements, using 2019 and 2021 as reference years. Primary data were collected to verify reporting accuracy in four purposively selected EmOC facilities. Data were disaggregated by facility level and ownership. Results: We included 255 facilities from 2016 to 2019 and 247 from 2020 to 2021; of which 30% were EmOC facilities. The overall completeness of data for deliveries and livebirths ranged between 53% and 55%, while it was < 2% for maternal deaths (98% of monthly values were zero). Among EmOC facilities, completeness was higher for deliveries and livebirths at 80%; and was < 6% for maternal deaths. For the whole sample, the prevalence of outliers for all three data elements was < 2%. Inconsistencies over time were mostly observed for maternal deaths, with the highest difference of 96% occurring in 2021. Conclusions: Routine data from childbirth facilities in Kampala were generally suboptimal, but the quality was better in EmOC facilities. Given likely underreporting of maternal deaths, further efforts to verify and count all facility-related maternal deaths are essential to accurately estimate facility-based maternal mortality. Data reliability could be enhanced by improving reporting practices in EmOC facilities and streamlining reporting processes in private-for-profit facilities. Further qualitative studies should identify critical points where data are compromised, and data quality assessments should consider service delivery standards. [ABSTRACT FROM AUTHOR]

Background: Approximately 15% of births worldwide result in life-threatening complications during pregnancy, delivery, or postpartum. Comprehensive Emergency Management of Obstetric and Newborn Care (CEmONC) is intended as one of the measures for maternal healthcare services to reduce the high burden with regard to childbirth complications. However, its state of implementation fidelity has not been well investigated. Therefore, this study aimed to evaluate the implementation fidelity of CEmONC services at University of Gondar Comprehensive Specialized Hospital, Ethiopia. Method: A case-study design with an embedded mixed method was employed. Adherence, quality of delivery, and participant responsiveness dimensions from Carroll's conceptual framework were used in this evaluation. Four hundred four exit interviews, 423 retrospective document reviews and 10 key informants were conducted. Moreover, a binary logistic regression model was fitted. The qualitative data were transcribed, translated, coded, and analysed using a thematic analysis approach. The overall implementation fidelity of the CEmONC was judged based on the pre-seated judgmental criteria. Results: Overall the implementation fidelity of the CEmONC service was 75.5%. Quality of delivery, participant responsiveness and adherence were 72.7%, 76.6% and 77.2% respectively. Signal functions like parenteral antibiotics and removal of retained products were insufficiently performed against the recommended protocols which was also evidenced by the key informant interviews. Healthcare providers' respect for the clients was less. Age ≥ 35 years (AOR = 0.48, 95% CI: 0.24,0.98), educational status of college and above (AOR = 2.61, 95% CI: 1.46,4.66), being government employed (AOR = 1.85, 95% CI: 1.08,3.18), having ANC follow-up (AOR = 5.50, 95% CI: 1.83, 16.47) and grand multigravida (AOR = 2.17, 95% CI: 1.08, 4.38) were factors significantly associated with participant responsiveness towards the services. Conclusions: The overall implementation fidelity of the CEmONC services was implemented in good fidelity. Moreover, the quality of delivery was judged as implemented in fair fidelity. Parenteral antibiotics and removal of retained products were not found to be sufficiently performed. Respect for the clients was insufficiently delivered. Therefore, it is recommended that parenteral antibiotics drugs be adequately provided and training for healthcare providers regarding compassionate and respectful care shall be facilitated. Moreover, healthcare providers are strongly recommended to adhere to the recommended guidelines. [ABSTRACT FROM AUTHOR]

Purpose: Women diagnosed with mid-trimester cervical insufficiency and dilatation are offered interventions to salvage and support the cervix, where the mainstay of therapy is emergency cervical cerclage. However, considering the significant morbidity associated with delivery in the extreme prematurity period, some women may opt for pregnancy termination. In addition, it is expected that elective cerclage in a subsequent pregnancy may yield better obstetrical results. The objective of this study was, therefore, to compare the obstetrical outcomes of emergency cerclage versus elective cerclage. Methods: This is a retrospective cohort study of the pregnancy outcomes of women with a singleton pregnancy who underwent cervical cerclage at our institution between December 2008 and November 2021. Women who underwent emergency cervical cerclage due to painless dilatation in the second trimester were compared with women who underwent elective cerclage. Results: Overall, 32 women who underwent emergency cerclage and 183 women who underwent elective cerclage were included. No cases of iatrogenic membrane rupture were noted during the cerclage procedure. There was no statistical difference between the emergency cerclage group and the elective cerclage group in the primary outcomes: gestational age at delivery (35.8 + 4.7 vs 36.3 + 4.9, p = 0.58, respectively), delivery in the extreme prematurity period (between 24 and 28 gestational weeks, 6.5% vs 2.3%, p = 0.21, respectively), and fetal or neonatal death (6.9% vs 6.3%, p = 0.91, respectively). Conclusion: Although there are much less favourable circumstances, emergency cerclage is a safe procedure with comparable obstetrical outcomes to elective cerclage. Patient selection and experienced medical team may play a significant role in those cases. [ABSTRACT FROM AUTHOR]

Background: Our institution implemented acute-care obstetric (OB) telemedicine (TeleOB) to address rural disparities across our health system. We sought to determine whether in situ simulations with embedded TeleOB consultation increase participants' comfort managing OB emergencies and comfort with and likelihood of using TeleOB. Methods: Rural site care teams participated in multidisciplinary in situ OB emergency simulations. Physicians in OB and neonatology at the referral center assisted via telemedicine consultation. Participants were surveyed before and after the simulations and six months later regarding their experience during the simulations. Results: Participants reported increased comfort with TeleOB activation, indications, and workflow processes, as well as increased comfort managing OB emergencies. Participants also reported significantly increased likelihood of using TeleOB in the future. Conclusions: Consistent with previous work, in situ simulation with embedded telemedicine consultations is an effective approach to facilitate telemedicine implementation and promote use by rural clinicians. [ABSTRACT FROM AUTHOR]

• Emergency contraception if correctly administered has a high safety profile, low risk of adverse effects and high efficacy. • Oral EC's mechanism is to inhibiting ovulation, with no influence after the implantation neither preventing implantation of a fertilized egg. • Ulipristal acetate has lowest rate of adverse effects, higher efficacy in preventing pregnancy and longer administration time slot. • Copper intrauterine device has the highest success rate in preventing pregnancy. • EC reduces the rate of induced abortions and their negative influence on physical and mental health. Emergency contraception includes several methods of contraception that can be used after unprotected sexual intercourse, after failure of any used method of contraception or in case of sexual abuse, to prevent pregnancy. The aim of the study was to analyze the available methods of emergency contraception, their mechanisms of action, efficacy, forms of administration, clinical applications and possible adverse effects. PubMed, Scopus and Cochrane datebases were searched for articles from 2010 to 2024 about emergency contraception. The analyzed types of emergency contraception included single oral dose of ulipristal acetate, single oral dose of levonorgestrel and intrauterine system releasing levonorgestrel or copper intrauterine device. Taking emergency contraception in the optimum time according to the drug characteristics allows for avoiding pregnancy in more than 90% of cases (depending on the type of emergency contraception and time from unprotected intercourse). The analyzed literature shows that intrauterine copper intrauterine device is the most effective method of emergency contraception, also together with intrauterine system releasing levonorgestrel leading to the lowest rate of adverse effects. Taking emergency contraception can result in various adverse effects, therefore it should be introduced after thorough analysis of woman's medical history, including gynecological and obstetric history and potential contraindications. Additionally, the patient should receive detailed information about the drug mechanism of efficacy and potential adverse effects. [ABSTRACT FROM AUTHOR]

Background: Sheehan's syndrome is a rare condition, which is classically characterized by anterior pituitary hypofunction following postpartum shock or hemorrhage. While diabetes insipidus (DI) is not commonly associated with Sheehan's syndrome, we present a rare case of a multiparous female developing rapid-onset panhypopituitarism and DI following severe postpartum hemorrhage. Case presentation: A previously healthy 39-year-old woman, gravida 5, para 4, presented with hypovolemic shock after vaginal delivery, attributed to severe postpartum hemorrhage, necessitating emergent hysterectomy. Although her shock episodes resolved during hospitalization, she developed intermittent fever, later diagnosed as adrenal insufficiency. Administration of hydrocortisone effectively resolved the fever. However, she subsequently developed diabetes insipidus. Diagnosis of Sheehan's syndrome with central diabetes insipidus was confirmed through functional hormonal tests and MRI findings. Treatment consisted of hormone replacement therapy, with persistent panhypopituitarism noted during a ten-year follow-up period. Conclusions: Sheehan's syndrome is a rare complication of postpartum hemorrhage. Central diabetes insipidus should be suspected, although not commonly, while the patient presented polyuria and polydipsia. Besides, the potential necessity for long-term hormonal replacement therapy should be considered. [ABSTRACT FROM AUTHOR]

Background: The evaluation of patients with first-trimester vaginal bleeding and concern for early pregnancy loss (EPL) frequently occurs in the emergency department (ED), accounting for approximately 1.6% of all ED visits.¹ Unfortunately, these patients consistently report negative experiences with ED care.2–8 In addition to environmental concerns, such as long wait times, patients often describe negative interactions with staff, including a perceived lack of empathy, the use of insensitive language, and inadequate counseling.2,3 These patients and their partners often view EPL as a traumatic loss of life and commonly experience prolonged grief reactions, including anxiety and depression.9–11 Poor satisfaction with care has been associated with worse mental health outcomes.12 These complaints represent an important opportunity for improvement in emergency medicine (EM) training.13 While no published literature to date describes the performance of EM residents in managing patients presenting with EPL, studies suggest that even obstetrics and gynecology (OB/GYN) residents find these interactions challenging.14,15 Simulation- and didactic-based training has been shown to be beneficial in improving OB/GYN resident EPL counseling and has been associated with improved patient outcomes.16 To our knowledge, this has yet to be replicated in EM residency training. Objectives: We aimed to develop and evaluate a simulation-based educational intervention to improve EM resident management of patients presenting with EPL. [ABSTRACT FROM AUTHOR]

Motivation: Addressing stunting in early childhood can have lasting effects on an individual's health, productivity, and well‐being in adulthood. By understanding the relationship between maternal healthcare policies and stunting, policy‐makers can design interventions that contribute to a healthier and more productive society. Purpose: This study investigated the effect of providing free healthcare to pregnant mothers on child stunting. Approach and method: The article uses doubly robust difference‐in‐difference estimator, drawing on Ghana Demographic and Health Survey. Findings: Free healthcare to mothers reduced stunting in the treatment regions by 12.3%. Evidence suggests the reform may have influenced children under the age of five through antenatal and delivery care attendance during pregnancy. Assistance during antenatal care and childbirth by health professionals improved significantly. Policy implications: Maternal health investment yields great health benefits for children from in utero to their fifth birthday. Maternal fee exemptions should be continued to maintain and further improve stunting reduction in children. Government should prioritize improving access to quality maternal healthcare services, including antenatal and skilled birth attendance and emergency obstetric care. [ABSTRACT FROM AUTHOR]

Objectives: To investigate risk factors for severe maternal morbidity (SMM) in pregnant women with hypertensive disorders of pregnancy (HDP) and to develop a risk prediction model. Methods: A prospective observational cohort study was conducted among pregnant women who were hospitalized for hypertensive disorders of pregnancy (HDP) between January 2016 and December 2020 in Fujian College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Province, China (a training set), and a risk predictive model was constructed. Pregnant women with HDP who were hospitalized between January 2021 and December 2021 were selected as a validation set. Concordance index (C-index) and calibration curves were used to test predictive model discrimination and calibration. Results: We included 970 pregnant women (790 in the training set and 180 in the validation set). Least absolute shrinkage and selection operator regression was used to screen for nine related variables such as intra-uterine growth retardation (IUGR), diastolic blood pressure (DBP) and systolic blood pressure (SBP) at suspected diagnosis, total bilirubin, albumin (ALB), uric acid, total cholesterol, serum magnesium, and suspected gestational age. SBP at suspected diagnosis (OR =1.22, 95%CI:1.08-1.42) and total cholesterol (OR = 1.78, 95% CI:1.17-2.80) were independent risk factors of severe maternal morbidity in pregnant women with HDP. A nomogram was constructed, and internal validation of the nomogram model was done using the bootstrap self-sampling method. C-index in the training and the validation set was 0.798 and 0.909, respectively. Conclusion: Our prediction model can be used to determine gestational hypertension severity in pregnant women. [ABSTRACT FROM AUTHOR]

Introduction: Peripartum hysterectomy is a rare emergency obstetric surgery, usually performed in emergency situations such as massive obstetric hemorrhage. Emergency peripartum hysterectomy (EPH) can follow a vaginal delivery or a cesarean section. Materials and methods: Our study is retrospective. It is done at the Department of Obstetrics and Gynaecology, Bangalore Medical College and Research Institute (Tertiary care teaching hospital in South India) from January 2018 to December 2023. Results: Out of 90,956 deliveries, EPH was performed in 162 cases. 0.178% is the incidence of EPH or it is about 1.8 per 1,000 deliveries. The commonest reason for EPH was abnormal placentation (43.8%). Atonic uterus (22.8%) and rupture uterus (20.3%) mostly secondary to scar rupture were the 2nd and 3rd most common causes of EPH. Discussion: Uncontrollable hemorrhage secondary to atonicity, ruptured uterus, and sepsis were once considered the principal risk factors for EPH. However, presently risk factors have changed and it is the abnormal placentation that considered to be the main indication for EPH. In this study, the most common indications of EPH were abnormal placentation, atonic uterus, ruptured uterus, and abruption. There were 13 maternal deaths (8.02%) in our study. A relatively low perinatal mortality rate (21.6%) is found in this study. Conclusion: Reducing the number of unnecessary cesarean deliveries, particularly repeat cesarean deliveries, in light of the evidence linking placental pathology with cesarean delivery, will help mitigate the number of EPH. [ABSTRACT FROM AUTHOR]

Aim and background: It is imperative to achieve precise diagnosis of prelabor rupture of membranes (PROM) and preterm prelabor rupture of membranes (PPROM) by recognizing specific amniotic fluid indicators in vaginal environment. The study included assessment of creatinine levels in vaginal fluid along with determining its cut-off value to diagnose PROM/PPROM. Methods: Sixty women with singleton pregnancy of 28 weeks or more period of gestation, were enrolled in the study to be categorized in two equal groups of 30 each. Study group comprised of patients having confirmed PROM and control group included pregnant women with intact membranes. Vaginal fluid samples were collected in a sterile syringe in study patients. In controls, 5 mL of normal (0.9%) saline was instilled into vaginal cavity, and 3 mL of vaginal fluid was collected to be sent for creatinine estimation. Results: The mean value of levels of creatinine in vaginal fluid in study groups was (1.15 ± 0.55 mg/dL) and control groups was (0.15 ± 0.16 mg/dL) showing a significant difference (p < 0.001). The value of creatinine in vaginal fluid to detect PROM/PPROM was 0.7 mg/dL, with sensitivity of 86.67% and specificity of 100%. The positive predictive value (PPV) was 100% and negative predictive value (NPV) was 88.24% with an accuracy of 93.33%. Conclusion: Creatinine estimation in vaginal fluid is an easy, reliable, as well as readily available method to diagnose PROM/PPROM. Clinical significance: Accurate diagnosis of PROM/PPROM, using an easily available and reliable method is important to guide the clinical management in high-risk pregnancy. [ABSTRACT FROM AUTHOR]

The article focuses on a comprehensive discussion about umbilical cord prolapse, a critical obstetric emergency. It covers various aspects related to managing such emergencies, including approaches in obstetric anesthesia and guidelines for safe obstetric delivery. The insights provided in the article are essential for healthcare professionals involved in obstetric care to effectively handle and mitigate the risks associated with umbilical cord prolapse during childbirth.

The spread of COVID-19 affected emergency medical care worldwide. Studies have observed various impacts of COVID-19, depending on the intensity of infection control measures, the number of medical facilities and the demographic composition of the region. However, reports on the impact on emergency medicine in rural cities or in the field of obstetrics and gynecology are limited. Therefore, the present study examined the impact of COVID-19 infection on the emergency transfer of patients with obstetric and gynecological diseases, where medical resources are limited. A cross-sectional study was conducted using a publicly available database. From 2019 to 2021, there were 635 obstetrics and gynecology transfers, which were divided into obstetric and gynecological diseases. The year 2019 was defined as the pre-pandemic period, while the other 2 years were labeled as the post-pandemic period. The number of transports, post-transportation outcomes and the percentage of transfers and the time required for transport were examined. The number of transfers did not change significantly during the post-pandemic period. In obstetric diseases, the number of transported patients who did not require hospitalization increased, and transfers from primary facilities decreased during the post-pandemic period. There was no change in severity or transport type for gynecological diseases, nor in the time required for transport for both obstetric and gynecological cases. The impact of infectious diseases on emergency transfers for obstetric and gynecological cases was considered low. Whether the increase in COVID-19 cases not requiring hospitalization and the decrease in transfers in obstetrics cases were due to the impact of infectious diseases remains unclear; thus, further studies are required. [ABSTRACT FROM AUTHOR]

One of the Sustainable Development Goals of the United Nations is to bring the global maternal mortality ratio down to less than 70 per 100,000 live births by 2030. Therefore, pinpointing the factors that influence maternal near-misses would help expedite the accomplishment of this goal. Studies on these topics are, nevertheless, scarce in the Hadiya zone and throughout Ethiopia as a whole. Therefore, the purpose of this study was to determine the factors that contribute to maternal near-misses among women who are admitted to public hospital maternity wards in the Hadiya zone in central Ethiopia. A facility-based, unmatched case-control study was conducted from February 17 to August 16, 2019. The study covered all secondary and tertiary public healthcare facilities in the Hadiya zone, which includes three district hospitals and one referral hospital offering comprehensive emergency obstetric care services. The study included 279 women in total (70 cases and 209 controls). Mothers who had had a near-miss were the cases, and mothers who had not had one were the controls. The Statistical Package for Social Sciences version 24 was used to analyze the data, and the multivariable binary logistic regression model was used to control confounders. The odds ratios (OR) and 95% confidence intervals (CI) were used to determine statistical significance at a p-value of less than 0.05. Living in a rural area [adjusted OR (AOR)=3.16; 95% CI: 1.62, 6.16], no birth preparedness (AOR=3.50; 95% CI: 1.66, 7.41), ever gave birth by cesarean section (AOR=3.68; 95% CI: 1.63, 8.31), previous history of hypertension (AOR=3.69; 95% CI:1.52, 8.96), and poor knowledge of pregnancy danger signs (AOR=3.15; 95% CI: 1.32, 7.52) were all determinants of maternal near-miss. Thus, strengthened public health and clinical interventions in these arenas need to prioritize rural women and women with a previous history of hypertension. [ABSTRACT FROM AUTHOR]

First trimester bleeding is commonly encountered in pregnancy and can be potentially life-threatening. Simulation training provides an ideal opportunity for resident medical learners to improve clinical knowledge and gain confidence inmanaging life-threatening causes of first trimester bleeding in a realistic but safe clinical environment. The objective of this study was to assess the effectiveness of simulation in improving family medicine residents' confidence and knowledge in identifying and managing first trimester bleeding in the emergency department (ED). The intervention was a two-hour educational simulation focusing on management of unstable first trimester bleeding. Twenty-one family medicine residents (67% female) at the University of Toronto participated in the simulation and completed pre- and post-simulation questionnaires assessing their confidence and knowledge in management of first trimester bleeding. This study demonstrates that simulation training improves resident physicians' confidence in managing first trimester bleeding in the ED. Additionally, it improves their objective history taking skills. Post-graduate medical programs should consider developing structured simulation, particularly for high-yield clinical cases residents may not otherwise have acute exposure to and are required to be competent in managing. [ABSTRACT FROM AUTHOR]

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Objective: To implement use of obstetric (OB) hospitalist telemedicine services (TeleOB) to support clinicians facing OB emergencies in low-resource hospital settings. Methods: TeleOB was staffed by OB hospitalists working at a tertiary maternity center. The service was available via real-time high-definition audio/video technology for providers at 17 outlying hospitals across a health system spanning two states. The initial 25 service activations are described. Results: TeleOB supported 17 deliveries, two postpartum emergency department (ED) consultations, and four antenatal ED consultations. In 10 of 17 (59%) deliveries, teleneonatology was jointly activated to support neonatal resuscitation. Sixteen (94%) deliveries occurred in multiparas, and five (29%) resulted from spontaneous preterm labor. Eighty percent (20/25) of activations occurred in facilities without maternity services. Conclusions: A TeleOB service staffed by OB hospitalists successfully supports hospitals in an integrated health care system. TeleOB is feasible for support of hospitals with no delivery facilities or with limited maternity care resources. [ABSTRACT FROM AUTHOR]

Introduction: Husband and wife as a couple are fully responsible for their current and future. In our society, the husband is mostly responsible for making the decision regarding any expenses. In India, there is a need to reduce the maternal mortality rate, and Husband’s involvement in antenatal care could be a key to success as it will enable them to support their partner in adequate preparation for birth and to utilize emergency obstetric care early if complications arise. Aim and Objectives: To find out about male involvement in the utilization of maternal healthcare services by their spouse and various factors affecting male involvement in the utilization of maternal healthcare services. Methods: This study was conducted in urban and rural field practice areas attached to the Department of Community Medicine, PGIMS, Rohtak. The study included 400 couples where 200 each were recruited from rural and urban areas. Out of 17 subcenters under CHC Chiri eight, subcenters were selected randomly by lottery method. A line list of these couples was prepared at each subcenter using ANC and birth register. Couples were enrolled from this line list till a sample size of 25 was reached at each of these eight subcenters. In this way, a total of 200 couples were enrolled from rural areas in which women delivered and availed maternal health services in the last 6 months. In urban areas, an equal number of couples were enrolled from each of these three urban health posts till the sample size of 200 was reached in an urban area. Results: The majority of the husbands (73%) reported that they participated in their wives’ utilization of maternal health services. Twenty‑seven percent did not participate in their wives’ utilization of maternal health services. It also showed that 71.0% of the husbands did not know about the investigations that needed to be performed during a woman’s pregnancy. Only 29% were aware of it. On analysis, it was observed that 73% of the husbands had good participation in their spouses’ maternal and child health (MCH) care, while the rest had poor participation (27%). It also showed that as the education level of the participants’ husbands increased, their participation in their spouses’ MCH care increased, with the highest being observed among graduates (91.3%) and the lowest among those with primary schooling level education (66.7%) which were statistically significant. [ABSTRACT FROM AUTHOR]

Background Placenta previa (PP) is one of the major causes of obstetric hemorrhage and is potentially life threatening to the mother and the baby. When the placenta is implanted partially or completely in the lower uterine segment, it is called as placenta previa. Previa is a Latin word meaning going before. The objective of this study is to analyze the incidence, risk factors, maternal morbidity, mortality and perinatal outcome in women with placenta previa at Cheluvamba hospital, MMCRI, Mysore. Methods This is retrospective observational study of all cases of placenta previa managed in the Department of Obstetrics and Gynecology, Mysore Medical College & Research Institute, Mysore, for a study period of 5 years from May 1st of 2018 to April 31st 2023. Results During our study period of 5 years, there were about 18,205 cesarean sections of which 1.19 % were complicated with placenta previa. About 47% of women belonged to 20-30 years age group and 62.6% were multigravida. There were 30.8% and 14.7% cases with previous cesarean sections and prior abortions respectively. In our study, 66.2% of the cases had postpartum hemorrhage of which 35.9% cases were managed medically, uterine artery and internal artery ligation was done in 12.9% and 3.6% cases respectively. About 1.84% of cases were found to have Adherent placenta and 5.0% cases underwent peripartum hysterectomy when postpartum hemorrhage could not be controlled by conservative methods. ICU admissions were 6.9% and one maternal death was recorded. 81.5% babies were preterm and 69% of them needed NICU admission with perinatal mortality culminating to 14.7%. Conclusion Placenta previa is one of the major obstetric entities leading to adverse maternal and perinatal outcome. Early diagnosis, Institutional delivery with multidisciplinary approach, availability of emergency obstetrics services with senior obstetricians can improve maternal and neonatal outcome in high-risk cases. Iatrogenic prematurity is a raising concern in placenta previa and its management. [ABSTRACT FROM AUTHOR]

The past 2 decades have seen dramatic growth in the number of obstetrics and gynecology hospitalists, and many hospitals have created obstetrical-specific emergency departments. The goals of an obstetrics emergency department are to provide safe and efficient care to the pregnant dyad and postpartum patient, while generating revenue for emergency services provided. In an obstetrics emergency department, all patients must be evaluated in person by a licensed practitioner, whereas historically they may have been evaluated in person by nursing staff or a trainee. We make the argument that formation of an obstetrics emergency department has the potential to improve the safety and quality of patient care. In addition, the financial benefits to institutions are substantial and can subsidize the cost of maintaining obstetrician presence all the time in the hospital. There are various regulatory requirements to become certified, accredited, and licensed as an emergency department. In addition, there are many operational and systems issues that institutions should consider before implementation. We provide a guide for healthcare systems considering creating an obstetrics emergency department. [ABSTRACT FROM AUTHOR]

Introduction: The United Nations has set a target to reduce global maternal deaths to less than 70 per 100,000 live births by 2030. However, despite high rates of institutional deliveries in Karnataka, a state in southern India, maternal mortality remains a significant challenge. This study aims to analyse a 10-year period of pregnancy-related deaths in a healthcare centre in Karnataka to identify the causes and avoidable factors contributing to maternal mortality. Material and Methods: A comprehensive review of records from 2009 to 2018 was conducted, gathering data on socio-demographic features, obstetric and medical history, referral details, duration of hospital stay until death, cause of death, organ dysfunction at admission and avoidable factors contributing to maternal death by inputs from expert committee. The percentages of incidences of causes were determined and analysed using binary logistic regression. Results:One hundred nine maternal deaths were reported during the study period. The majority of these deaths occurred in rural areas, with infections and obstetric haemorrhage being the primary causes. A significant number of deaths occurred within 24 hours of admission, including during the postpartum period, with approximately one-fourth of cases being critically ill and nearly half of the cases had multiorgan dysfunction. Delay in seeking health services (42.8%) and failure to recognize early features of infection (36.3%) emerged as a common contributing factor tomaternal deathss. The presence of any delay in receiving obstetric care (odds ratio [OD]= 3.31), referral status (OD= 3.20), and rural residence (OD=3.06) were significant factors contributing to instability at the time of admission. Conclusions: This study underscores the urgent need to address preventable factors contributing to maternal deaths in Karnataka. Strategies should focus on reducing delays in seeking care, improving recognition and management of infection during pregnancy and enhancing access to emergency obstetric services, particularly for women in rural areas. [ABSTRACT FROM AUTHOR]

Background: Australian Aboriginal and Torres Strait Islander women with diabetes in pregnancy (DIP) are more likely to have glycaemic levels above the target range, and their babies are thus at higher risk of excessive fetal growth. Shoulder dystocia, defined by failure of spontaneous birth of fetal shoulder after birth of the head requiring obstetric maneuvers, is an obstetric emergency that is strongly associated with DIP and fetal size. The aim of this study was to investigate the epidemiology of shoulder dystocia in Aboriginal babies born to mothers with DIP. Methods: Stratifying by Aboriginal status, characteristics of births complicated by shoulder dystocia in women with and without DIP were compared and incidence and time-trends of shoulder dystocia were described. Compliance with guidelines aiming at preventing shoulder dystocia in women with DIP were compared. Post-logistic regression estimation was used to calculate the population attributable fractions (PAFs) for shoulder dystocia associated with DIP and to estimate probabilities of shoulder dystocia in babies born to mothers with DIP at birthweights > 3 kg. Results: Rates of shoulder dystocia from vaginal births in Aboriginal babies born to mothers with DIP were double that of their non-Aboriginal counterparts (6.3% vs 3.2%, p < 0.001), with no improvement over time. Aboriginal mothers with diabetes whose pregnancies were complicated by shoulder dystocia were more likely to have a history of shoulder dystocia (13.1% vs 6.3%, p = 0.032). Rates of guideline-recommended elective caesarean section in pregnancies with diabetes and birthweight > 4.5 kg were lower in the Aboriginal women (28.6% vs 43.1%, p = 0.004). PAFs indicated that 13.4% (95% CI: 9.7%-16.9%) of shoulder dystocia cases in Aboriginal (2.7% (95% CI: 2.1%-3.4%) in non-Aboriginal) women were attributable to DIP. Probability of shoulder dystocia among babies born to Aboriginal mothers with DIP was higher at birthweights > 3 kg. Conclusions: Aboriginal mothers with DIP had a higher risk of shoulder dystocia and a stronger association between birthweight and shoulder dystocia. Many cases were recurrent. These factors should be considered in clinical practice and when counselling women. [ABSTRACT FROM AUTHOR]

Pregnancy-related gastric cancer is characterized by a refractory nature and poor prognosis; few gastric cancer cases during pregnancy achieved acceptable outcomes by using anti-PD-1 as a monotherapy. A 32-year-old pregnant female patient was admitted to the emergency department of the obstetrics and gynecology department and eventually diagnosed with gastric cancer. Radical surgery for gastric cancer was conducted after the termination of pregnancy. At 1-year postoperative follow-up, tumor recurrence was revealed. This patient has achieved a decrease in tumor burden after receiving anti-PD-1 as a monotherapy. This case documents tumor response to PD-1 monotherapy in pregnancy-related gastric cancer and highlights the potential for future use in specific clinical scenarios. [ABSTRACT FROM AUTHOR]

BACKGROUND AND OBJECTIVES: Acute Kidney Injury as a complication in pregnancy contributes to a high rate of morbidity and mortality in our country. The aim of this study is to analyze the variouscausesofacutekidneyinjuryinpregnancy, thefactorsaffectingitscourseand to determine the outcome of pregnancy in the affected cases. This is necessary to help in the early diagnosis and prevention of complications to the mother and the child. OBJECTIVES: The objectives are to study the etiological profile of acute kidney injury in pregnancy and to study the clinical course of acute kidney injury in pregnancy. METHODS: This is a prospective cohort study, conducted over a period of one and half years with a total of 53 pregnant patients with acute kidney injury admitted to a tertiary care hospital and those without previous history of hypertension, diabetes mellitus or renal disease. The subjects were observed and serum urea, creatinine and hemoglobin levels assessed and progress noted. The final prognosis was then charted and analyzed. RESULTS Ourstudyshowedthat43.39%patientsbelongedtotheagegroupsof 26-30 years and 47.1% were primi patients. 85% recovered and only 15 % mortality was seen in the study group.60.38% had blood urea levels between 40-100 mg/dl and 47.12%hadbloodcreatininelevelsbetween1-2mg/dl.49%patientshadhemoglobin levels between 7-9.9mg/dl. Most common cause for acute kidney injury in our studyis due to hypertensive disorders of pregnancy. INTERPRETATION AND CONCLUSION: This concludes that pre-eclampsia is the most frequent etiology followed by post-partum hemorrhage and abruptio placenta. This concludes that prevention is the best and least expensive solution. Prenatal care and greater access to emergency obstetric care services could decrease pregnancy related acute kidney injury and its consequences. [ABSTRACT FROM AUTHOR]

Background: Obstetrical emergencies are stressful events that need to be identified and managed by the health care providers to ensure the best possible clinical outcomes. Therefore, there is a critical need to improve nurses' performance regarding obstetrical emergencies during pregnancy. Aim: The current study aimed to determine the effect of educational program on nurses' performance regarding obstetrical emergencies during pregnancy. Subjects and Method: A quasi-experimental research design was used. Three hospitals were used for this study: Tanta University (Main Hospital), El-Menshawy, and EL-Mabara Hospital. The study was conducted at the obstetrics departments' antenatal units. This study included all available nurses (50 nurses) at the previously mentioned settings. Study tools: Tool one: Nurses' Knowledge regarding Obstetrical Emergencies during Pregnancy and Tool two: Nurses' Practices Observational Checklist. Results: The results revealed a highly statistically significant improvement of nurses' performance regarding obstetrical emergencies during pregnancy immediately and three months' following the educational program implementation (p=0.000). Conclusion: The educational program regarding obstetrical emergencies during pregnancy was effective to enhance nurses' performance. Recommendations: The study suggested creating ongoing training courses to improve and freshen nurses' abilities to handle obstetrical emergencies. [ABSTRACT FROM AUTHOR]

Introduction: One of the targets for the third sustainable development goals is to reduce worldwide maternal mortality ratio (MMR) to less than 70 deaths per 100,000 live births by 2030. To address issues affecting women and the newborns during childbirth and postnatal period, concerted efforts from governments and their stakeholders are crucial to maximize the use of technology to enhance frontline health professionals' skills to provide the emergency obstetric and newborn care (EmONC). However, no study has garnered nurses' and midwives' perspectives regarding the application of technology-enhanced learning approach to provide on-the-job Continuous Professional Development (CPD) and factors that may influence the application of this training approach in the Rwandan context. Methods: The study collected data from nurses and midwives from forty (40) public health facilities in remote areas nationwide. The study applied a qualitative descriptive design to explore and describe nurses' and midwives' perspectives on the feasibility and acceptability of technology enhanced learning approaches such as e-learning, phone-based remote training, and other online methods to provide trainings in EmONC. Two focus group discussions with EmONC mentors, two with nurses and midwives were conducted. Twelve key informant interviews were conducted. Participants were selected purposively. In total, 54 individuals were included in this study. A thematic approach was used to analyse data. Results: Nurses and midwives highlighted the need to provide refresher trainings about the management of pre-eclampsia. Most of the EmONC trainings are still provided face-to-face and the use of technology enhanced learning approaches have not yet been embraced in delivering EmONC CPDs for nurses and midwives in remote areas. Nurses and midwives found the first developed prototype of smartphone app training of the EmONC acceptable as it met the midwives' expectations in terms of the knowledge and skills' gap in EmONC. Conclusion: Although the newly developed application was found acceptable, further research involving practical sessions by nurses and midwives using the developed application is needed to garner views about the ease of use of the application, relevance of the EmONC uploaded content on the app, and needed improvements on the app to address their needs in EmONC. [ABSTRACT FROM AUTHOR]

Background: Sub-Saharan Africa is unlikely to achieve sustainable development goal (SDG) 3 on maternal and neonatal health due to perceived sub-standard maternal and newborn care in the region. This paper sought to explore the opinions of stakeholders on intricacies dictating sub-standard emergency obstetric and newborn care (EmONC) in health facilities in Northern Ghana. Methods: Drawing from a qualitative study design, data were obtained from six focus group discussions (FGDs) among 42 health care providers and 27 in-depth interviews with management members, clients and care takers duly guided by the principle of data saturation. Participants were purposively selected from basic and comprehensive level facilities. Data analysis followed Braun and Clarke's qualitative thematic analysis procedure. Results: Four themes and 13 sub-themes emerged as root drivers to sub-standard care. Specfically, the findings highlight centralisation of EmONC, inadequate funding, insufficient experiential training, delay in recruitment of newly trained essential staff and provider disinterest in profession. Conclusion: Setbacks in the training and recruitment systems in Ghana, inadequate investment in rural health coupled with extent of health provider inherent disposition to practice may be partly responsible for sub-standard obstetric care in the study area. Interventions targeting the afore-mentioned areas may reduce events of sub-standard care. What is already known on this subject?: Quality of emergency obstetric and newborn care is sub-standard in sub-Saharan Africa. What this study adds?: Sub-standard emergency obstetric and newborn care in rural Ghana may be due to hitches in placement, training and recruitment processes, centralisation of EmONC, inadequate funding, insufficient experiential training, delay in posting of newly trained essential staff and provider disinterest in profession. Adequate and timely resourcing of health facilities and standardisation of admission procedures into schools may reduce events of sub-standard care. [ABSTRACT FROM AUTHOR]

Background: In 2016, the WHO regional office for Europe prepared a manual for conducting routine facility based individual near miss case review cycle. This study evaluates the effectiveness of the individual near miss case review (NMCR) cycle in improving quality of emergency obstetric care and maternal outcome in Keren hospital. Methods: An interrupted time series design was used to achieve the objectives of this study. Monthly data on women with potentially life-threatening conditions (PLTCs) admitted between April 2018 and October 2022 (i.e. 33 months pre-implementation and 22 months post-implementation) were collected from medical records. Segmented regression analysis was used to assess the intervention's effect on three process and outcome measures, namely, SMO, delayed care, and substandard care. The intervention was expected a priori to show immediate improvements without time-lag followed by gradual increment in slope. Segmented regression analyses were performed using the "itsa' command in STATA. Results: During the entire study period, 4365 women with potentially life threatening conditions were identified. There was a significant reduction in the post-implementation period in the proportion of mothers with PLTC who experienced SMO (− 8.86; p < 0.001), delayed care (− 8.76; p < 0.001) and substandard care (− 5.58; p < 0.001) compared to pre-implementation period. Results from the segmented regression analysis revealed that the percentage of women with SMO showed a significant 4.75% (95% CI: − 6.95 to − 2.54, p < 0.001) reduction in level followed by 0.28 percentage points monthly (95% CI: − 0.37 to − 0.14, p < 0.001) drop in trend. Similarly, a significant drop of 3.50% (95% CI: − 4.74 to − 2.26, p < 0.001) in the level of substandard care along with a significant decrease of 0.21 percentage points (95% CI: − 0.28 to − 0.14, p < 0.001) in the slope of the regression line was observed. The proportion of women who received delayed care also showed a significant 7% (95% CI: − 9.28 to − 4.68, p < 0.001) reduction in post-implementation level without significant change in slope. Conclusions: Our findings suggest that the WHO individual NMCR cycle was associated with substantial improvements in quality of emergency obstetric care and maternal outcome. The intervention also bears a great potential for scaling-up following the guidance provided in the WHO NMCR manual. [ABSTRACT FROM AUTHOR]