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Background: Maternal death reviews and obstetric audits identify causes and circumstances related to occurrence of a maternal death or serious complication and inform improvements in quality of care. Given Nigeria's high maternal mortality, the lessons learned from past experiences can provide a good evidence base for informed decision making. We aimed to synthesise findings from maternal death reviews and other obstetric audits conducted in Nigeria through a systematic review, seeking to identify common barriers and enabling factors related to the provision of emergency obstetric care. Methods: We searched for maternal death reviews and obstetric care audits reported in the published literature from 2000-2014. A 'best-fit' framework approach was used to extract data using a structured data extraction form. The articles that met the inclusion criteria were assessed using a nine point quality score. Results: Of the 1,841 abstracts and titles at initial screening, 329 full text articles were reviewed and 43 papers fulfilled the inclusion criteria. Four types of barriers were reported related to: transport and referral; health workers; availability of services; and organisational factors. Three elements stand out in Nigeria as contributing to maternal mortality: delays in Caesarean section, unavailability of magnesium sulphate and lack of safe blood transfusion services. Conclusions: Obstetric care reviews and audits are useful activities to undertake and should be promoted by improving the processes used to conduct them, as well as extending their implementation to rural and basic level health facilities and to the community. Urgent areas for quality improvement in obstetric care, even in tertiary and teaching hospitals should focus on organisational factors to reduce delays in conducting Caesarean section and making blood and magnesium sulphate available for all who need these interventions. [ABSTRACT FROM AUTHOR]

Background: Millions of women give birth annually without the support of a trained birth attendant. Generally and globally, countries provide maternal health services for their citizens but there is a coverage gap for undocumented migrant women who often can't access the same care due to their legal status. The objective of this investigation is to explore undocumented migrants' experiences and perceptions of maternal healthcare accessibility. Methods: We held focus groups discussions with 64 pregnant women at 3 migrant health clinics on the Thailand–Myanmar border and asked how they learned about the clinic, their health care options, travel and past experiences with birth services. In this context undocumented women could sign up for migrant health insurance at the clinic that would allow them to be referred for tertiary care at government hospitals if needed. Results: Women learned about care options through a network approach often relying on information from community members and trusted care providers. For many, choice of alternate care was limited by lack of antenatal care services close to their homes, limited knowledge of other services and inability to pay fees associated with hospital care. Women travelled up to 4 h to get to the clinic by foot, bicycle, tractor, motorcycle or car, sometimes using multiple modes of transport. Journeys from the Myanmar side of the border were sometimes complicated by nighttime border crossing closures, limited transport and heavy rain. Conclusions: Undocumented migrant women in our study experienced a type of conditional or variable accessibility where time of day, transport and weather needed to align with the onset of labour to ensure that they could get to the migrant clinic on time to give birth. We anticipate that undocumented migrants in other countries may also experience conditional accessibility to birth care, especially where travel is necessary due to limited local services. Care providers may improve opportunities for undocumented pregnant women to access maternal care by disseminating information on available services through informal networks and addressing travel barriers through mobile services and other travel supports. Trial registration The research project was approved by Research Ethics Committee at the Faculty of Medicine, Chiang Mai University (FAM-2560-05204), and the Department of Community Medicine and Global Health at the University of Oslo—Norwegian Centre for Research Data (58542). Plain Language Summary: Undocumented pregnant migrants have difficulties and limitations in accessing maternal health care services. Although the governments have tried to provide maternal health care services to all, there is still a gap in coverage among this population. This study explores how undocumented pregnant migrants perceive their ability to access maternal health care and share their experiences when utilizing it. We used focus groups to interview 64 pregnant women at three migrant health clinics on the Thailand–Myanmar border. We asked how they learned about the clinic, their health care options, travel, and past experiences with birth services. The results showed that they usually knew about care options from community members and trusted care providers. The limitations for the choice of alternate care were due to a lack of services close to their homes, limited knowledge of other services, inability to pay hospital fees, and difficulty traveling from their residence to the clinic. Therefore, we anticipate that undocumented migrants in other countries may also experience difficulties in accessibility to birth care, especially where travel is necessary due to limited local services. Care providers may improve opportunities for these migrants to access maternal care by disseminating information on available services through informal networks and addressing travel barriers through mobile services and other travel supports. [ABSTRACT FROM AUTHOR]

Background: Vaccination is one of the most reliable interventions against coronavirus disease 2019 (COVID-19). Although pregnant women's attitudes toward COVID-19 vaccination are well studied, husbands' views toward COVID-19 vaccination for these women have not been surveyed. We aimed to determine the rates and associated factors of accepting attitudes toward COVID-19 vaccination during pregnancy among Thai pregnant women and their spouses and to evaluate the actual rate of vaccination during pregnancy among these women. Methods: A prospective survey was conducted at a tertiary care center in Bangkok, Thailand. A total of 176 Thai pregnant woman/husband dyads who attended our antenatal care clinic between 1 July 2021 and 30 September 2021 were consecutively recruited for evaluations of their accepting attitudes toward COVID-19 vaccination during pregnancy. After delivery, data on COVID-19 vaccination during pregnancy among pregnant women were extracted from the hospital's electronic database. Results: After exclusion of five pregnant women with prepregnancy COVID-19 vaccination, 171 women and 176 male partners were included. The rates of accepting attitudes toward COVID-19 vaccination during pregnancy were 60.8% and 61.4%, respectively. Multivariate analysis showed that having a husband who favored COVID-19 vaccination for his wife was independently associated with COVID-19 vaccine acceptance among pregnant women (adjusted odds ratio 4.82; 95% confidence interval 2.34, 9.94). However, confidence in vaccine safety was an associated factor of the husband's willingness to have his wife vaccinated for COVID-19 during pregnancy (adjusted odds ratio 12.56; 95% confidence interval 2.35, 67.18). The actual rate of vaccination during pregnancy was 88.3%. Conclusions: Although the rates of accepting attitudes toward COVID-19 vaccination during pregnancy among Thai pregnant women and their spouses were modest, the actual rate of being vaccinated during pregnancy was high. Plain language summary: Vaccination is an important tool to fight against the coronavirus disease 2019 (COVID-19) pandemic. In this study, we investigated the rates and associated factors of accepting attitudes toward COVID-19 vaccination during pregnancy among Thai pregnant women and their spouses. The actual rate of vaccination during pregnancy among the enrolled women was also evaluated. We recruited 176 Thai pregnant woman/husband dyads who attended our antenatal care clinic between 1 July 2021 and 30 September 2021. The results showed that 60.8% of pregnant women and 61.4% of husbands had accepting attitudes toward COVID-19 vaccination during pregnancy. Having a husband who favored COVID-19 vaccination for his wife was a significant factor for COVID-19 vaccine acceptance among pregnant women, whereas confidence in vaccine safety was a significant predictor of the husband's willingness to have his wife vaccinated for COVID-19 during pregnancy. The majority (96.2%) of the women who accepted vaccination were vaccinated against COVID-19 during pregnancy. On the other hand, 76.1% of the women who were initially reluctant to be vaccinated ultimately received COVID-19 vaccines during pregnancy. The actual rate of being vaccinated among the enrolled women was 88.3%. Given the results of this study, physicians, hospital administrators, and policymakers should focus on those who show vaccine hesitancy or refusal and implement intensive interventions because there is a possibility to change their attitudes if they have more knowledge and gain more trust in the vaccines. [ABSTRACT FROM AUTHOR]

Objectives: To determine the prevalence of stress and depression and associated factors among women seeking a first-trimester induced abortion in China. Methods: A cross-sectional study was conducted in a tertiary hospital in Beijing, from April 1st to Oct 31st, 2021. Women seeking termination of an intrauterine first-trimester pregnancy were invited to participate and complete a digital self-administered questionnaire. The survey included socio-demographic and health questions, Perceived Stress Scale-10 (PSS-10), and Patient Health Questionnaire-9 (PHQ-9). Descriptive analyses and binary logistic regression analyses were performed using SPSS 23.0. Results: A total of 253 women participated. Prevalence of high perceived stress (cut-off ≥ 20) and depressive symptoms (cut-off ≥ 10) was 25.3% and 22.5%, respectively. Women were more likely to suffer high stress if they reported low resilience (aOR = 16.84, 95% CI 5.18–54.79), were not-using contraceptives (aOR = 3.27, 95% CI 1.39–6.29), had low social support (aOR = 2.95, 95% CI 1.39–6.29), were non-local residents (aOR = 2.51, 95% CI 1.15–5.92), were dissatisfied with their intimate relationship (aOR = 2.44, 95% CI 1.15–5.16), or held pro-life attitudes towards abortion (aOR = 1.04, 95% CI 1.18–3.53). Odds of experiencing depression were higher among women who also reported high perceived stress (aOR = 19.00, 95% CI 7.67–47.09), had completed higher education (aOR = 12.28, 95% CI 1.24–121.20), and were non-local residents (aOR = 3.38, 95% CI 1.37–8.32). Conclusions: The magnitude of perceived stress and depression was high among Chinese women seeking a first-trimester induced abortion. It is necessary to comprehensively evaluate the mental health of women seeking an abortion, especially those with high risk. Interventions to mitigate relevant associated factors could improve the psychological wellbeing of women. Plain language summary: Abortion is a stressful life event. Understanding how women perceive having an abortion and their psychosocial responses will enable health providers to understand women's needs and provide high-quality care. This study aims to determine the frequency of stress and depression among women seeking an induced abortion in early pregnancy in China and associated factors Around 25.3% of women reported high stress and 22.5% reported depression. Women were more likely to suffer high stress if they reported low resilience, were not-using contraceptives, had low social support, were non-local residents, were unhappy with their intimate relationship, or held pro-life attitudes towards abortion. High perceived stress, high education level, and non-local status were associated with depression. The findings indicate stress and depression are quite common among women seeking an abortion in China, especially those with high-risk factors. It is necessary to evaluate and promote the mental health of women seeking an abortion. [ABSTRACT FROM AUTHOR]

Background: Many studies have considered maternal age as a determinant factor for success in assisted reproductive technologies (ART), but the potential role of paternal age on neonatal outcomes has been overlooked. This study aimed to explore the association between paternal age and birthweight in frozen embryo transfer (FET) cycles. Methods: This retrospective study involved singleton live births born to women undergoing frozen embryo transfer from January 2013 to December 2017 at a tertiary care center in Shanghai, China. The paternal age was classified into four categories: ≤ 30, 31–35, 36–40, and ≥ 41 years. The group consisting of respondents with paternal age of 31–35 was set as the reference group. Singleton birthweight was the primary outcome measure. Z-scores were calculated according to gestational age and newborn gender on birthweight based on the national birthweight reference. Multivariable linear regression analysis was performed to reveal the relationship between paternal age and newborns' birthweight after considering several potential confounders. Results: Exactly 9765 women who fulfilled the inclusion criteria were enrolled. No significant difference was found on mean birthweight (P = 0.082) and gestation-adjusted Z-scores (P = 0.569) among paternal age categories. The reference group and the group with aged 36–40 years had the highest mean birthweight and Z-scores, respectively (3350.2 ± 467.8 g, 0.36 ± 1.00). A decline in mean birthweight with paternal age was observed, and the group over 40 years had the lowest value of 3309.4 ± 474.3 g, but the difference was not statistically significant. In multivariate analyses, the adjusted odds of very low birthweight (LBW), LBW, and high birthweight in the reference group did not significantly differ with the three other groups. After correcting several potential confounders, no significant correlation was observed between paternal age and neonatal birthweight (P = 0.289). Conclusion: Paternal age was not associated with mean birthweight and gestational age- and gender-adjusted birthweight (Z-scores) of singletons among women who became pregnant in FET cycles. Plain English summary: Currently, many couples delay childbearing until after the age of 40. The natural decline of fertility of elderly couples forces them to utilize assisted reproductive technology. Although males continuously produce sperm throughout their entire life, their sperm quality decreases, changes occur in reproductive hormones, the incidence of de novo mutations increases, and negative behavioral choices could cause a decline in males' fertility potential after the age of 40. Due to their age women may also face fertility issues that have an impact on pregnancy and childbirth. This study only included couples who had successfully given birth in frozen embryo transfer cycles. Considering that birthweight is an important indicator of neonatal health, we explored the association between paternal age and singleton birthweight. Our study found that paternal age is not associated with mean birthweight and gestational age- and gender-adjusted birthweight (Z-scores) of singletons in FET cycles, showing chances of successful pregnancy in couples over 40 years of age have improved. [ABSTRACT FROM AUTHOR]

Background: The majority of the world's perinatal deaths occur in low- and middle-income countries. A substantial proportion occurs intrapartum and is avoidable with better care. At a low-resource tertiary hospital, this study assessed the quality of intrapartum care and adherence to locally-tailored clinical guidelines. Methods: A non-participatory, structured, direct observation study was held at Mnazi Mmoja Hospital, Zanzibar, Tanzania, between October and November 2016. Women in active labour were followed and structure, processes of labour care and outcomes of care systematically recorded. Descriptive analyses were performed on the labour observations and compared to local guidelines and supplemented by qualitative findings. A Poisson regression analysis assessed factors affecting foetal heart rate monitoring (FHRM) guidelines adherence. Results: 161 labouring women were observed. The nurse/midwife-to-labouring-women ratio of 1:4, resulted in doctors providing a significant part of intrapartum monitoring. Care during labour and two-thirds of deliveries was provided in a one-room labour ward with shared beds. Screening for privacy and communication of examination findings were done in 50 and 34%, respectively. For the majority, there was delayed recognition of labour progress and insufficient support in second stage of labour. While FHRM was generally performed suboptimally with a median interval of 105 (interquartile range 57–160) minutes, occurrence of an intrapartum risk event (non-reassuring FHR, oxytocin use or poor progress) increased assessment frequency significantly (rate ratio 1.32 (CI 1.09–1.58)). Conclusions: Neither international nor locally-adapted standards of intrapartum routine care were optimally achieved. This was most likely due to a grossly inadequate capacity of birth attendants; without whom innovative interventions at birth are unlikely to succeed. This calls for international and local stakeholders to address the root causes of unsafe intrafacility care in low-resource settings, including the number of skilled birth attendants required for safe and respectful births. [ABSTRACT FROM AUTHOR]

Background: Haiti's maternal mortality, stillbirth, and neonatal mortality rates are the highest in Latin America and the Caribbean. Despite inherent risks, the majority of women still deliver at home without supervision from a skilled birth attendant. The purpose of this study was to elucidate factors driving this decision. Methods: We conducted six focus group discussions with women living in urban (N = 14) or rural (N = 17) areas and asked them questions pertaining to their reasons for delivering at a facility or at home, perceptions of staff at the health facility, experiences with or knowledge of facility or home deliveries, and prior pregnancy experiences (if relevant). We also included currently pregnant women to learn about their plans for delivery, if any. Results: All of the women interviewed acknowledged similar perceived benefits of a facility birth, which were a reduced risk of complications during pregnancy and access to emergency care. However, many women also reported unfavorable birthing experiences at facilities. We identified four key thematic concerns that underpinned women's negative assessments of a facility birth: being left alone, feeling ignored, being subject to physical immobility, and lack of compassionate touch/care. Taken together, these concerns articulated an overarching sense of what we term "isolation," which encompasses feelings of being isolated in the hospital during delivery. Conclusion: Although Haitian women recognized that a facility was a safer place for birthing than the home, an overarching stigma of patient neglect and isolation in facilities was a major determining factor in choosing to deliver at home. The Haitian maternal mortality rate is high and will not be lowered if women continue to feel that they will not receive comfort and compassionate touch/care at a facility compared to their experience of delivering with traditional birth attendants at home. Based on these results, we recommend that all secondary and tertiary facilities offering labor and delivery services develop patient support programs, where women are better supported from admission through the labor and delivery process, including but not limited to improvements in communication, privacy, companionship (if deemed safe), respectful care, attention to pain during vaginal exams, and choice of birth position. [ABSTRACT FROM AUTHOR]

Background: Around 5.4 million under-five deaths occur globally annually. Over 2.5 million neonatal deaths and an equivalent stillbirths also occur annually worldwide. India is largest contributor to these under-five deaths and stillbirths. To meet the National Health Policy goals aligned with sustainable development targets, adoption of specific strategy and interventions based on exact causes of death and stillbirths are essential. The current cause of death (CoD) labelling process is verbal autopsy based and subject to related limitations. In view of rare diagnostic autopsies, the minimally invasive tissue sampling (MITS) has emerged as a suitable alternate with comparable efficiency to determine CoD. But there is no experience on perception and acceptance for MITS in north Indian context. This formative research is exploring the perceptions and view of families, communities and healthcare providers regarding MITS to determine the acceptability and feasibility. Methods: The cross-sectional study adopts exploratory qualitative research design. The study will be conducted in New Delhi linked to deaths and stillbirths occurring at a tertiary care hospital. The data from multiple stakeholders will be collected through 53–60 key-informant in-depth interviews (IDIs), 8 focus group discussions (FGDs) and 8–10 death or stillbirth event observations. The IDIs will be done with the parents, family members, community representatives, religious priests, burial site representatives and different health care providers. The FGDs will be conducted with the fathers, mothers, and elderly family members in the community. The data collection will focus on death, post-death rituals, religious practices, willingness to know CoD, acceptability of MITS and decision making dynamics. Data will be analysed following free listing, open coding, selective coding and theme identification. Subsequently 8–10 parents will be approached for consent to conduct MITS using the communication package to be developed using the findings. Discussion: The study will provide in-depth understanding of the cultural, social, religious practices related to child death and stillbirth and factors that potentially determine acceptance of MITS. The findings will guide development of communication and counselling package and strategies for obtaining consent for MITS. The pilot experience on obtaining consent for MITS will inform suitable refinement and future practice. [ABSTRACT FROM AUTHOR]

Background: In Pakistan, deaths from preeclampsia/eclampsia (PE/E) represent one-third of maternal deaths reported at tertiary care hospitals. To reduce the morbidity and mortality associated with PE/E, an accessible strategy is to support pregnant women at high risk for preeclampsia (HRPE) by closely monitoring their blood pressures at home (i.e., telemonitoring) for the earliest signs of preeclampsia. This could lead to the earliest possible detection of high blood pressure, resulting in early intervention such as through medications, hospitalization, or delivery of the baby. The study aims to explore the perspectives, preferences and needs of telemonitoring (TM) for pregnant women at HRPE in Karachi, to inform future implementation strategies. Methods: The study will employ an exploratory qualitative research design. The study will be conducted at the Jinnah Postgraduate Medical Centre (JPMC) hospital and Aga Khan University Hospital (AKUH) in Karachi, Sindh, Pakistan. Data will be collected through key-informant interviews (KIIs) and in-depth patient interviews (IDPIs). IDPIs will be conducted with the pregnant women at HRPE who are visiting the out-patient department/ antenatal clinics of JPMC hospital for antenatal check-ups and immunizations. KIIs will be conducted with the obstetricians, Maternal, neonatal and child health (MNCH) specialists and health care providers at JPMC, as well as TM experts from Karachi. Study data will be analyzed through conventional content analysis. Interviews are anticipated to begin in April 2020 and to be completed during the summer of 2020. Discussion: This is the first study to explore the use of TM program for pregnant women at HRPE in a tertiary health facility in Karachi. The research will help explore perceived benefits associated with the use of a TM program alongside potential facilitators and barriers that may help inform the future implementation of a TM program for pregnant women at HRPE in Karachi. [ABSTRACT FROM AUTHOR]

Background: Gamete and embryo donors undergo genetic screening procedures in order to maximise the health of donor-conceived offspring. In the era of genomic medicine, expanded genetic screening may be offered to donors for the purpose of avoiding transmission of harmful genetic mutations. The objective of this study was to explore the attitudes of donors and recipients toward the expanded genetic screening of donors. Methods: Qualitative interview study with thematic analysis, undertaken in a tertiary fertility centre. Semi-structured in-depth qualitative interviews were conducted with eleven recipients and nine donors from three different cohorts (sperm, egg and embryo donors/recipients). Results: Donors and recipients acknowledged the importance of genetic information and were comfortable with the existing level of genetic screening of donors. Recipients recognised some potential benefits of expanded genetic screening of donors; however both recipients and donors were apprehensive about extended genomic technologies, with concerns about how this information would be used and the ethics of genetic selectivity. Conclusion: Participants in donor programs support some level of genetic screening of donors, but are wary of expanding genetic screening beyond current levels. [ABSTRACT FROM AUTHOR]