High Maternal Mortality Research Articles

Effectiveness of a Mobile Phone Messaging-Based Message Framing Intervention for Improving Maternal Health Service Uptake and Newborn Care Practice in Rural Jimma Zone, Ethiopia: Protocol for a Cluster Randomized Controlled Trial.

Ethiopia has high rates of maternal and neonatal mortality. In 2019 and 2020, the maternal and newborn mortality rates were estimated at 412 per 1,000,000 births and 30 per 10,000 births, respectively. While mobile health interventions to improve maternal and neonatal health management have shown promising results, there are still insufficient scientific studies to assess the effectiveness of mobile phone messaging-based message framing for maternal and newborn health. This research aims to examine the effectiveness of mobile phone messaging-based message framing for improving the use of maternal and newborn health services in the Jimma Zone, Ethiopia. A 3-arm cluster-randomized trial design was used to evaluate the effects of mobile phone-based intervention on maternal and newborn health service usage. The trial arms were (1) gain-framed messages (2) loss-framed messages, and (3) usual care. A total of 21 health posts were randomized, and 588 pregnant women who had a gestational age of 16-20 weeks, irrespective of their antenatal care status, were randomly assigned to the trial arms. The intervention consisted of a series of messages dispatched from the date of enrolment until 6-8 months. The control group received existing care without messages. The primary outcomes were maternal health service usage and newborn care practice, while knowledge, attitude, self-efficacy, iron supplementation, and neonatal and maternal morbidity were secondary outcomes. The outcomes will be analyzed using a generalized linear mixed model and the findings will be reported according to the CONSORT-EHEALTH (Consolidated Standards of Reporting Trials of Electronic and Mobile HEalth Applications and onLine TeleHealth) statement for randomized controlled trials. Recruitment of participants was conducted and the baseline survey was administered in March 2023. The intervention was rolled out from May 2023 till December 2023. The end-line assessment was conducted in February 2024. This trial was carried out to understand how mobile phone-based messaging can improve maternal and newborn health service usage. It provides evidence for policy guidelines around mobile health strategies to improve maternal and newborn health. Pan African Clinical Trials Registry PACTR202201753436676; https://tinyurl.com/ykhnpc49. DERR1-10.2196/52395.

Prevalence of Iron Deficiency Anaemia Among Pregnant Women Attending Primary Health Care Center Malala Dukku Local Government Area of Gombe State, Nigeria

Iron deficiency anaemia in pregnancy is an important health issue resulting in high maternal morbidity and mortality. The purpose of the current study was to identify the prevalence of iron deficiency anaemia among pregnant women attending primary healthcare center malaladukku local government of Gombe state, the researcher pick interest on the topic as a result of high rate of anaemia in pregnancy in the research setting primary healthcare center malala, a cross sectional descriptive non-experimental design was adopted by the researcher. Questionnaire was used as a tool for data collection various literature were review which include conceptual review, theoretical review, and empirical review of prevalence, causes and preventive measures. The study assesses the prevalence iron deficiency anaemia among pregnant women, causes of iron deficiency anaemia, and the preventive measures of the condition. The result of the study shows that the prevalence of iron deficiency was high at (74.9%) many factors were considered responsible with the condition as revealed by the research work which includes previous history of the condition, imbalanced nutrition 66.6% () and malaria in pregnancy. Supplementary iron therapy during pregnancy 83.3% (), antenatal services as soon as pregnancy is confirmed, sleeping under mosquito treated net (58.3%) s and chief alternative of healthy diet (46.6%) are the preventive measures of iron deficiency anaemia as revealed by the study. There is also need for further studies on ways of preventing and reducing the rate of iron deficiency anaemia. The research work will help in enlightening the midwives, healthcare providers on the disease and its preventive measures wsith regards to clinical practice and it will also add to the body of knowledge in the medical field and the researcher’s knowledge on the condition.

Spontaneous rupture of uterine during pregnancy after laparoscopic myomectomy: A case report

The danger of future uterine rupture is a serious concern for women who become pregnant after uterine leiomyomectomy or adenomyomectomy, despite the fact that these procedures are commonly used to alleviate symptoms like dysmenorrhea or hypermenorrhea and improve fertility. Although it happens very infrequently, uterine rupture is the most dreaded pregnancy complication and is linked to a high rate of maternal and fetal morbidity and mortality. Here, we present a case of spontaneous uterine rupture during the third trimester of pregnancy.

Healthcare workers’ views on decentralized primary health care management in Lesotho: a qualitative study

BackgroundLesotho experienced high rates of maternal (566/100,000 live births) and under-five mortality (72.9/1000 live births). A 2013 national assessment found centralized healthcare management in Ministry of Health led to fragmented, ineffective district health team management. Launched in 2014 through collaboration between the Ministry of Health and Partners In Health, Lesotho’s Primary Health Care Reform (LPHCR) aimed to improve service quality and quantity by decentralizing healthcare management to the district level. We conducted a qualitative study to explore health workers’ perceptions regarding the effectiveness of LPHCR in enhancing the primary health care system.MethodsWe conducted 21 semi-structured key informant interviews (KII) with healthcare workers and Ministry of Health officials purposively sampled from various levels of Lesotho’s health system, including the central Ministry of Health, district health management teams, health centers, and community health worker programs in four pilot districts of the LPHCR initiative. The World Health Organization’s health systems building blocks framework was used to guide data collection and analysis. Interviews assessed health care workers’ perspectives on the impact of the LPHCR initiative on the six-health system building blocks: service delivery, health information systems, access to essential medicines, health workforce, financing, and leadership/governance. Data were analyzed using directed content analysis.ResultsParticipants described benefits of decentralization, including improved efficiency in service delivery, enhanced accountability and responsiveness, increased community participation, improved data availability, and better resource allocation. Participants highlighted how the reform resulted in more efficient procurement and distribution processes and increased recognition and status in part due to the empowerment of district health management teams. However, participants also identified limited decentralization of financial decision-making and encountered barriers to successful implementation, such as staff shortages, inadequate management of the village health worker program, and a lack of clear communication regarding autonomy in utilizing and mobilizing donor funds.ConclusionOur study findings indicate that the implementation of decentralized primary health care management in Lesotho was associated a positive impact on health system building blocks related to primary health care. However, it is crucial to address the implementation challenges identified by healthcare workers to optimize the benefits of decentralized healthcare management.

Systemic Lupus Erythematosus in pregnancy – a multidisciplinary approach to family planning and adverse outcomes prevention

Introduction and purpose Systemic Lupus Erythematosus is a chronic multisystemic autoimmune disease with periods of remissions and flares [1,5,25]. Because of its possible consequences and unpredictability, it is undoubtedly an issue for such patients to decide about pregnancy [3]. The main aim of this review is to present the possible risks of SLE in pregnancy, its general management and current recommendations regarding pregnancy planning and pre-/postnatal care. Review Methods For the review we conducted research of scientific literature from PubMed and books, applying the keywords (below). Consequently, we included in our references above 20 selected articles published between 2017-2024 and 3 chapters of different medical books. All of these were analyzed in terms of their currency and relevance. A brief description of the State of Knowledge SLE mostly affects women at the reproductive age [2, 3,5]. It often requires long-term therapy that aims to achieve and maintain an inactive stage by means of numerous aggressive drugs. Its proper management in gestation is even more challenging than usually, owing to the increased risk of adverse pregnancy outcomes (APO) and higher maternal mortality [1,2,4,5,7]. Therefore, to achieve successful pregnancy, risk stratification, therapy modification and individually adjusted plan of follow-up visits are the most crucial conditions to be met [1,6,7,13]. Summary Considering all the potential complications that may occur in general, the issue of family planning should be raised with every female patient [5,6]. The key to the best outcomes is proper implementation of current strategies and empowering the patient to be an active and aware participant in the decision-making process [1,3,4,6,11].

Education of postpartum hemorrhage management clinical skills among midwifery students in Malawi: A qualitative study

BackgroundUnskilled health professionals in healthcare systems are contributing to the high numbers of maternal mortality in Malawi. It is therefore essential that midwifery students acquire postpartum hemorrhage management clinical skills, especially in view of high maternal mortality, with postpartum hemorrhage being the leading cause. However, there is limited evidence on how the teaching is conducted with regard to students’ learning of postpartum hemorrhage management clinical skills. PurposeThis study aimed to describe the current teaching of postpartum hemorrhage management clinical skills in undergraduate nursing and midwifery program in Malawi. MethodsThe study applied a qualitative exploratory descriptive design. Data were collected through ten individual interviews with lecturers and three focus group discussions with twenty-four students in a midwifery education program in Malawi. The data were analyzed using thematic analysis. ResultsTwo themes emerged from the data analysis: (1) there are various teaching and learning approaches for postpartum hemorrhage management in use and (2) unpreparedness of midwifery students in postpartum hemorrhage management for patient care. ConclusionThe present study demonstrated that teaching of postpartum hemorrhage management clinical skills in an undergraduate nursing and midwifery programme in Malawi focuses on theoretical knowledge rather than practical skills, leaving midwifery students unprepared for postpartum hemorrhage management during clinical practice. The findings from the present study may provide knowledge guiding revision of the curriculum for the undergraduate nursing and midwifery programme in Malawi to consider global standards of midwifery education; enhance the lecturer to student ratio to provide the students with appropriate supervision; and to employ innovative teaching and learning strategies that promote peer education and skills practice among midwifery students. In addition, to conduct more research related to various teaching approaches in nursing and midwifery educational programs and among qualified midwives in Malawi. Statement of significancePostpartum hemorrhage management education in undergraduate nursing and midwifery programme in Malawi focuses more on theory than clinical skills. Improving midwifery students' acquisition of postpartum hemorrhage management clinical skills is needed to ultimately help lower Malawi's maternal mortality ratio.

Neno Boha: Local Wisdom of the Dawan Community tn Postpartum Mothers in Binaus Village

Introduction: Health promlems in Indonesia include high maternal and infant mortality rates. The causes are varied, including economic factors, access to health facilities, and community beliefs and traditions. In Binaus Village, there is a Neno Boha tradition for caring for mothers after giving birth, which involves roasting, hot water compresses (tatobi), abstinence, and consuming potions. This research aims to understand the implementation of the Neno Boha tradition and its impact on maternal and infant health Methods: This research uses a qualitative method with an ethnographic approach to postpartum mothers who follow the Neno Boha tradition. Data was collected through in-depth interviews and participant observation, then analyzed thematically by coding the interview transcripts to produce sub-themes and themes. The results are presented in descriptive text. Results: Data analysis shows that the Dawan tribe women in Binaus Village still carry out the Neno Boha tradition because of this belief passed down from generation to generation. They believe that this tradition helps restore health and heal post-natal wounds. Mothers continue to observe Neno Boha even after giving birth in a health facility and taking medication, because they believe this tradition prevents various long-term illnesses. The practice of roasting and tatobi is thought to help expel dirty blood, making the mother feel healthier. However, for the sake of the baby's health, the practice of roasting is now done only with hot coals and in the main house Conclusion: Traditional care for mothers after giving birth is still carried out by the Dawan tribe community in Binaus Village. The mother feels that the Neno Boha tradition needs to be carried out in addition to medical treatment, by avoiding things that could harm the mother and baby.

Cesarean birth decision-to-delivery interval in sub-Saharan Africa: A systematic review and meta-analysis

Background: Globally, in 2017, 810 women died daily from pregnancy- or childbirth-related preventable complications. Of these deaths, 94% occurred in resource-poor countries, with the highest maternal and perinatal mortality occurring in sub-Saharan Africa (SSA). We conducted a systematic review and meta-analysis of studies on the decision-to-delivery interval (DDI) from the SSA to determine the mean DDI, establish the maternal and neonatal outcomes reported, and evaluate the obstacles to achieving the gold standard DDI of ≤30 minutes. Methods: We performed a systematic literature review and meta-analysis of eligible studies between January 1995 and December 2022, in seven databases and grey literature. Studies of any design were included if they reported obstetric emergencies delivered by cesarean birth and had information on the DDI. Three independent reviewers applied eligibility criteria, assessed the risk of bias, and extracted data. The authors performed meta-analysis of mean DDI on studies with adequate data. Results: Thirty-nine studies with 41 datasets (12,835 participants), qualified for inclusion. In these studies, only 6.34% of cesarean deliveries were performed in under 30 minutes. A meta-analysis of 27 datasets found an overall DDI mean of 2.81 hours (168.8 minutes, 95%CI 151.5 to 186.2)). The pooled perinatal and maternal case fatality rates for the included studies were 61.2 in 1000 and 444.1 in 100,000 CDs, respectively. Conclusion: This review and meta-analysis found unacceptably high mean DDI, and perinatal and maternal mortality following cesarean delivery in SSA.

Suicide Mortality During the Perinatal Period

The US has the highest maternal mortality rate among developed countries. The Centers for Disease Control and Prevention deems nearly all of these deaths preventable, especially those attributable to mental health conditions. Coordination between US health care and social service systems could help further characterize circumstances and risks associated with perinatal suicide mortality. To examine contextual and individual precipitating circumstances and risks associated with perinatal suicide. This cross-sectional observational study used a convergent mixed methods design to explore factors contributing to maternal suicides and deaths of undetermined intent (hereinafter, undetermined deaths) identified in National Violent Death Reporting System (NVDRS) data for January 1, 2003, to December 31, 2021. Analyses included decedents who were aged 10 to 50 years and pregnant or post partum at death (collectively, the perinatal group) and demographically matched female decedents who were not pregnant or recently pregnant (nonperinatal group) at death. Analyses were performed between December 2022 and December 2023. Pregnancy status at death (perinatal or nonperinatal). The main outcomes included contributing circumstances associated with suicides and undetermined deaths cited in coroner, medical examiner, or law enforcement case narratives. The study examined quantitative differences between groups using a matched analysis and characterized key themes of salient suicide circumstances using qualitative content analysis. This study included 1150 perinatal decedents identified in the NVDRS: 456 (39.6%) were pregnant at death, 203 (17.7%) were pregnant within 42 days of death, and 491 (42.7%) were pregnant within 43 to 365 days before death, yielding 694 postpartum decedents. The nonperinatal comparison group included 17 655 female decedents aged 10 to 50 years. The mean (SD) age was 29.1 (7.4) years for perinatal decedents and 35.8 (10.8) years for nonperinatal decedents. Compared with matched nonperinatal decedents, perinatal decedents had higher odds of the following identified contributing circumstances: intimate partner problems (IPPs) (odds ratio [OR], 1.45 [95% CI, 1.23-1.72]), recent argument (OR, 1.33 [95% CI, 1.09-1.61]), depressed mood (OR, 1.39 [95% CI, 1.19-1.63]), substance abuse or other abuse (OR, 1.21 [95% CI, 1.03-1.42]), physical health problems (OR, 1.37 [95% CI, 1.09-1.72]), and death of a family member or friend (OR, 1.47 [95% CI, 1.06-2.02]). The findings of the qualitative analysis emphasized the importance of mental health and identified 128 decedents (12.4%) with postpartum depression. This study provides insights into complex factors surrounding maternal suicide, and it highlights opportunities for further research to understand long-term consequences of perinatal mental health. These findings also underscore the need for targeted evidence-based interventions and effective policies targeting mental health, substance use, and IPPs to prevent maternal suicide and enhance maternal health outcomes.

Maternal death by cancer in pregnancy: A descriptive study of the International Network on Cancer, Infertility and Pregnancy.

To characterise pregnant women diagnosed with primary or recurrent cancer who died during pregnancy, during delivery or within 1 year postpartum. A descriptive study. The registry of the International Network on Cancer, Infertility and Pregnancy (INCIP). Women diagnosed with cancer during pregnancy between 2000 and 2022. Using the INCIP registry database, we compared the characteristics of all women with cancer who died during pregnancy, delivery or within 1 year postpartum with those of all women with cancer who survived the first year postpartum. Maternal and tumour characteristics and obstetrical and neonatal outcomes. Of the 2359 women registered in INCIP, there were 131 cases (5.6%) of maternal mortality. Lung cancer (9/14, 64.3% of all registered women with lung cancer), gastro-oesophageal cancer (13/21, 61.9%) and acute leukaemia (17/105, 16.2%) had the highest rates of maternal mortality. Maternal mortality was associated with fewer live births compared with the control group without maternal mortality (99/131, 75.6%, vs 1952/2163, 90.0%; P < 0.001), more elective caesarean sections (64/104, 60.4%, vs 756/1836, 41.2%; P < 0.001) and a lower gestational age at (induced) delivery (34.0 vs 37.1 weeks; P < 0.001), resulting in more preterm births. Maternal mortality occurred in 5.6% of cancer-in-pregnancy cases and is associated with adverse perinatal outcomes.

Addressing obstetric violence: a scoping review of interventions in healthcare and their impact on maternal care quality.

The mistreatment and abuse of women during childbirth have been recognized as a major global health challenge, impeding facility-based delivery and contributing to the high maternal mortalities globally. The World Health Organization has specifically called for interventions to deal with obstetric violence. This scoping review consolidates the existing literature on interventions aimed at reducing obstetric violence and synthesizes existing knowledge on their impact in promoting respectful maternity care. Thirteen electronic databases were searched for relevant articles from January 2001 to March 2023. A total of 863 records were identified, and 72 full-text articles were retrieved for further screening. The review includes 16 studies, particularly from low- and middle-income countries, with interventions implemented at medical facilities and involving both women and healthcare providers. Eight of the studies were quantitative, three were qualitative and five used a mixed-methods approach. The results reveal a promising trend in reducing obstetric violence through various interventions. Ten different types of interventions were identified, highlighting strategies to improve the quality of maternity care and enhance patient-centered care. Improved patient-provider communication skills, increased privacy measures, and reduced abuse and mistreatment emerged as common themes. Enhanced communication skills, including open discussions and the right to be informed, were crucial in reducing obstetric violence. Privacy measures, such as separate rooms, curtains, and birth companions effectively decreased incidents of non-confidential care. General abuse and mistreatment, including physical abuse and neglect, were also reduced, leading to improved perceptions of respectful care during childbirth. Overall, the interventions had a favorable impact on obstetric violence reduction and women's childbirth experiences. However, despite promising results, obstetric violence remains prevalent worldwide, necessitating more efforts to implement effective interventions. To the best of our knowledge, this is the first scoping review on obstetric violence interventions, providing a comprehensive overview of the state of the art. We suggest that further research is needed to explore new interventions, particularly gender-sensitive interventions, to contribute to a growing body of knowledge on the prevention of obstetric violence.

Predictive scores for critically ill obstetric patients in a resource‐limited setting: A retrospective validation of the Obstetric Early Warning Score.

Background. In South Africa (SA), an unacceptably high institutional maternal mortality rate persists due to failure to recognise critically ill patients. Early warning systems could assist in identifying these patients sooner. Objectives. We evaluated the Obstetric Early Warning Score (OEWS) as a predictor of maternal outcomes in an intensive care unit (ICU) and compared its prognostic validity with the Acute Physiology and Chronic Health Evaluation (APACHE) II and the quick Sequential Organ Failure Assessment score (qSOFA). Methods. Data were extracted on pregnant and post-partum ICU-admitted patients at a tertiary and regional centre in SA between October 2015 and April 2020. Clinical characteristics and outcomes were used to compare the three scoring systems. Results. Among 251 eligible patients, the mortality rate was 8.5%. The OEWS score failed to differentiate between survivors and non-survivors (odds ratio 1.13, 95% confidence intervals (CI) 0.972 - 1.311, p=0.113). APACHE II outperformed the OEWS (area under the receiver operating characteristics curve (AUROC) 0.69, 95% CI 0.540 - 0.846 v. 0.55, 95% CI 0.430 - 0.674). The OEWS (AUROC 0.55, 95% CI 0.430 - 0.674) and qSOFA (AUROC 0.60, 95% CI 0.500 - 0.703) showed no differences. Further analysis revealed that positive scoring for diastolic blood pressure and high systolic blood pressure weakened OEWS performance. Removing these variables improved OEWS prediction (AUROC 0.68). Conclusion. In a SA obstetric population, OEWS did not predict mortality in ICU-admitted patients and offered no advantages over APACHE II or qSOFA scores. Further research should identify critical outcome predictors for low-resource populations.

Understanding maternal Ethnomedical Folklore in Central Uganda: a cross-sectional study of herbal remedies for managing Postpartum hemorrhage, inducing uterine contractions and abortion in Najjembe sub-county, Buikwe district

Pregnant women in rural Uganda largely rely on medicinal plants for inducing labor, treating postpartum hemorrhage (PPH), and inducing abortion. 90% of the women in both rural and urban Uganda use plants to manage pregnancy symptoms like constipation, heartburn, morning sickness, body aches, nausea, and vomiting. After delivery women continue using plants to manage postpartum complications and for infant care especially herbal baths. This study documented how ethnomedical folklore has been used to aid childbirth, manage postpartum hemorrhage, and induce abortion.MethodsA cross-sectional ethnobotanical survey was conducted from May – December 2023 in Najjemebe sub-county, Buikwe district. 206 respondents from 12 villages were selected using snowball sampling. Key informants included Traditional Birth Attendants (TBAs) and herbalists. Data was collected using semi-structured questionnaires and focus group discussions. Voucher specimens of the plants were identified and authenticated at Makerere University Herbarium. Data were analyzed using descriptive statistics, Informant Consensus factor (ICF), Use Reports (URs), paired comparisons, and GraphPad Prism® version 9.0.0 software.ResultsAll respondents (N = 206, 100%), used plants to induce labour, treat PPH, and induce abortion. One hundred four plant species were documented: most cited or preferred were: Hoslundia opposita (N = 109, 53%), Phytolacca dodecandra (N = 72, 35%), and Commelina erecta (N = 47, 23%). The plants belonged to 49 families, Lamiaceae (16.3%) and Fabaceae (14.3%) having the majority of the species. Herbs were 42 (40%) and trees 23 (22%). Oral administration 95(72%) was the commonest, then topical 19 (14.4%) and vaginal 14(10.6%).ConclusionHealth surveys revealed that about 27% of deliveries in Uganda take place outside a health facility. Due to the oxytocic effects of plant species reported in this study, they play a triple role of being uterotonics, abortifacients, and treating postpartum haemmorhage. The dilemma lies in the unknown dosages and toxicity levels that could endanger both the mother’s and the unborn child’s lives. Due to Uganda’s high rates of population growth, overall fertility, maternal mortality, and morbidity, policies, and programmes on gendered health provision need to be reevaluated. Integrating herbal medicine into health care systems appears to be a feasible solution.

The Relationship Of The Quality Of Antenatal Care (Anc) Services With The Level Of Pregnant Women's Satisfaction

This study aims to explore the relationship between the quality of antenatal care (ANC) services and the satisfaction levels of pregnant women at the Kuta Raja Community Health Center, Banda Aceh. This relationship is pivotal in understanding how service quality impacts maternal satisfaction and, ultimately, maternal health outcomes. Maternal Mortality Rate (MMR) is defined as the number of mothers who die during postpartum, pregnancy, and childbirth. High MMR is often attributed to a lack of awareness and infrequent ANC visits. In 2023, only 86.25% of pregnant women attended ANC services, falling short of the 93% target. Initial observations indicated that 60% of the attendees were dissatisfied with the ANC services at the Kuta Raja Community Health Center. This analytical survey, employing a cross-sectional design, was conducted at the Kuta Raja Community Health Center. The study population included 93 pregnant women, all of whom were surveyed using a total sampling technique. Data were analyzed using univariate and bivariate analyses, with the chi-square test employed for bivariate analysis. The study found that certain quality dimensions of ANC services—responsiveness (p &lt; 0.001), assurance (p &lt; 0.005), empathy (p &lt; 0.005), and tangibility (p &lt; 0.001)—were significantly related to the satisfaction levels of pregnant women. However, reliability (p &gt; 0.05) showed no significant relationship with satisfaction. There is a significant relationship between the responsiveness, assurance, empathy, and tangibility of ANC services and the satisfaction levels of pregnant women at the Kuta Raja Community Health Center. Conversely, reliability did not show a significant correlation with satisfaction. To improve maternal satisfaction and health outcomes, it is recommended that pregnant women regularly attend ANC services and that efforts be made to enhance the quality dimensions that impact satisfaction.

Maternal morbidity and death associated with pregnancy loss before 28 weeks in Nigeria.

To determine the prevalence of maternal morbidity and death from pregnancy loss before 28 weeks in referral-level hospitals in Nigeria. Secondary analysis of a nationwide cross-sectional study. Fifty-four referral-level hospitals. Women admitted for complications arising from pregnancy loss before 28 weeks between 1 September 2019 to 31 August 2020. Frequency and type of pregnancy loss were calculated using the extracted data. Multilevel logistic regression was used to determine sociodemographic and clinical factors associated with early pregnancy loss. Factors contributing to death were also analysed. Prevalence and outcome of pregnancy loss at <28 weeks; sociodemographic and clinical predictors of morbidity after early pregnancy loss; contributory factors to death. Of the 4798 women who had pregnancy loss at <28 weeks of pregnancy, spontaneous abortion accounted for 49.2%, followed by missed abortion (26.9%) and ectopic pregnancy (15%). Seven hundred women (14.6%) had a complication following pregnancy loss and 99 women died (2.1%). Most complications (26%) and deaths (7%) occurred after induced abortion. Haemorrhage was the most frequent complication in all types of pregnancy loss with 11.5% in molar pregnancy and 6.9% following induced abortion. Predictors of complication or death were low maternal education, husband who was not gainfully employed, grand-multipara, pre-existing chronic medical condition and referral from another facility or informal setting. Pregnancy loss before 28 weeks is a significant contributor to high maternal morbidity and mortality in Nigeria. Socio-economic factors and delays in referral to higher levels of care contribute significantly to poor outcomes for women.

A Call to Action: Supporting Black Maternal and Infant Health Using the Collective Impact Model.

This commentary advocates for a comprehensive approach to addressing the Black maternal and infant health crisis, utilizing the collective impact model with health equity at its center. Black women in the United States face alarmingly high rates of maternal morbidity and mortality compared to white women. Black women are twice as likely to have premature and low birthweight babies than white women, exposing both the expectant woman and child to various health risks. This crisis stems from systemic racism, implicit bias in healthcare, and a lack of targeted health communications for pregnant Black women. The urgency of this situation requires a bold and unified response through collaboration and coordination among healthcare providers, local and grassroots community-based organizations (CBOs), and digital health communicators. A comprehensive Black maternal and infant health campaign embedded within the collective impact model and led by a dedicated backbone organization would facilitate the coordination and involvement of diverse stakeholders. Central to these efforts should be the acknowledgment that systemic racism perpetuates health inequities. Consequently, any initiatives to improve health outcomes should prioritize health equity by valuing and incorporating Black women's perspectives. This involves crafting a responsive strategy and placing Black women at the forefront of content creation, program strategy, and evaluation. Through a collaborative effort involving healthcare partners, CBOs, and health communicators, we can have an impact far more significant than any single initiative. Immediate action is needed to dismantle systemic barriers and ensure every Black woman and infant receives the care and support they deserve. Black maternal health disparities in the United States have been widely acknowledged and studied. It is well-established that Black women face significantly higher rates of maternal morbidity and mortality compared to their white counterparts, indicative of a severe healthcare crisis. This opinion piece contributes to the discourse by proposing a comprehensive solution grounded in the collective impact model, which emphasizes collaboration and coordination across various stakeholders. This approach represents a shift from past siloed efforts, aiming to tackle the urgent issue of Black maternal and infant health with a multidisciplinary approach centered on health equity.

Addressing Maternal Perinatal Mortality: State Responsibility in Primary Health Care in Perú

Using data from the Comprehensive Health Insurance, this study examined Primary Health Care (PHC) and disparities in maternal-perinatal health in Peru. Its primary goal was to assess how PHC affected the decline in high and persistent maternal and perinatal mortality. The investigation also encompassed regional inequities and unequal access to health services. The study used a technique that integrated a qualitative approach, a review of scientific literature, and data analysis. It made clear how crucial it is to address inequality characteristics such as sociocultural accessibility, geographic, and economic in order to enhance care in the nation. The findings demonstrate the necessity of resolving these disparities in order to improve prenatal and maternal care. The present study offers a robust basis for subsequent inquiries and the development of evidence-based health policies. The Ministerio de la Mujer y Poblaciones Vulnerables (2021) recommended changes in health policy, which this study supports in order to enhance the health of vulnerable people and reduce inequities in access to maternal-perinatal care. The study also highlights the critical necessity of PHC in Peru. Its primary contributions are to deepen our understanding of disparities in obstetric treatment and to set the stage for future studies and national health policy.

Impact of SARS-CoV-2 infection during pregnancy on the placenta and fetus

Pregnant people and their fetuses are vulnerable to adverse health outcomes from coronavirus 2019 disease (COVID-19) due to infection with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). COVID-19 has been associated with higher rates of maternal mortality, preterm birth, and stillbirth. While SARS-CoV-2 infection of the placenta and vertical transmission is rare, this may be due to the typically longer time interval between maternal infection and testing of the placenta and neonate. Placental injury is evident in cases of SARS-CoV-2-associated stillbirth with massive perivillous fibrin deposition, chronic histiocytic intervillositis, and trophoblast necrosis. Maternal COVID-19 can also polarize fetal immunity, which may have long-term effects on neurodevelopment. Although the COVID-19 pandemic continues to evolve, the impact of emerging SARS-CoV-2 variants on placental and perinatal injury/mortality remains concerning for maternal and perinatal health. Here, we highlight the impact of COVID-19 on the placenta and fetus and remaining knowledge gaps.

The Effect of Auricular Acupressure on Uterine Contractions, Fetal Heart Rate, and Length of Labor in the Active Phase of Primigravida

The still high maternal mortality rate (MMR) in Indonesia, especially in East Java, is caused by indirect causes or other causes such as prolonged labor, so a method is needed to treat cases of prolonged labor such as auricular acupressure. Auricular acupressure (AKAR) is a non-pharmacological method proven effective for uterine contractions, but its side effects on the fetal heart rate (FHR) are unknown. The research aimed to analyze the AKAR method on uterine contractions, FHR, and labor duration in the first stage's active phase. This type of research is truly experimental, with a pretest-posttest control group design. The research subjects were 41 respondents, primigravida active phase first-stage mothers, selected by consecutive sampling and randomly divided into two groups, namely 21 AKAR groups and 20 deep breathing relaxation control groups. The research results of the Friedman test statistical test ρ-value equal 0.000 in the AKAR group and ρ-value equal 0.000 in the control group, meaning that AKAR influences uterine contractions. The Friedman Test findings show that AKAR does not affect FHR (ρ-value equal 0.618). The Independent Sample Test ρ-value equal 0.29 indicates no statistically significant difference between the two groups' labor lengths throughout the first stage's active phase. The AKAR group's average labor time in the first stage of the active phase was 365.40 minutes, with a minimum of 267 minutes and a high of 395 minutes. Conclusion: The auricular acupressure method affects uterine contractions but does not affect the fetal heart rate. There was no difference in the length of labor in the first active phase of labor between the auricular acupressure and deep breathing relaxation groups, so it is recommended that the auricular acupressure method can be used as an alternative complementary care to prevent prolonged labor.

ANAEMIA, EXPECTANT MOTHERS AND DIETARY HABITS: ISSUES AND CONCERNS

The problem of anaemia among expectant mothers, instead of declining has increased over the years at the all India level and also in almost all the states of the country though differentially. These revelations come from the comparative analysis of the NFHS- 4 and NFHS- 5 data on anaemia released in the year 2000 and 2022 respectively. A review of the studies attributes the problem to inadequate nutritious food available to the expectant mothers during the period of pregnancy when the need of the body for iron and calcium increases for the proper growth of the foetus. In the absence of which the women are unable to bear the pressures of bleeding in the pre and post delivery period, leading to low weight baby birth and premature births, and at times resulting in high maternal mortality. This paper examines the status of anaemia among expectant mothers and its relationship with dietary habits.