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Objective: To assess the impact on postpartum hemorrhage (PPH) of a smartphone training application called “Safe Delivery”, distributed to midwives. Design: A cluster randomized controlled trial. Setting: Greater Accra Region, Ghana. Population: 146 midwives were randomly allocated to intervention (70 midwives, seven hospitals, 1,665 deliveries) or control (76 midwives, eight hospitals, 1,746 deliveries). Methods: The intervention group received Safe Delivery which is a smartphone training tool in Emergency Obstetric and Neonatal Care. Main Outcome Measures: The primary outcome was PPH. Secondary outcomes were severe PPH and the relative difference in postpartum blood loss. Results: The intervention was associated with an insignificant lower incidence of PPH (odds ratio 0.86 (95% confidence interval (CI) 0.59 to 1.25)) and an insignificant lower incidence of severe PPH: odds ratio .95 (95% CI: .65 to 1.40). The relative difference in blood loss between intervention and control arms was: 5.3% (95% CI: −3.2%, to13.8%). The intra-class correlation for hospitals was .016, and for midwives within hospitals: .026. Conclusions: Safe Delivery was associated with an insignificant lower incidence of PPH. The validity of the blood loss data was a concern since the data collection was not completely uniformly and this imprecision could not be evaluated. The study questions whether Safe Delivery works as a stand-alone tool to improve basic emergency obstetric and neonatal care.

While the risk of ovarian cancer clearly reduces with each full-term pregnancy, the effect of incomplete pregnancies is unclear. We investigated whether incomplete pregnancies (miscarriages and induced abortions) are associated with risk of epithelial ovarian cancer. This observational study was carried out in female participants of the European Prospective Investigation into Cancer and Nutrition (EPIC). A total of 274,442 women were followed from 1992 until 2010. The baseline questionnaire elicited information on miscarriages and induced abortions, reproductive history, and lifestyle-related factors. During a median follow-up of 11.5 years, 1,035 women were diagnosed with incident epithelial ovarian cancer. Despite the lack of an overall association (ever vs. never), risk of ovarian cancer was higher among women with multiple incomplete pregnancies (HR(≥4vs.0): 1.74, 95% CI: 1.20-2.70; number of cases in this category: n = 23). This association was particularly evident for multiple miscarriages (HR(≥4vs.0): 1.99, 95% CI: 1.06-3.73; number of cases in this category: n = 10), with no significant association for multiple induced abortions (HR(≥4vs.0): 1.46, 95% CI: 0.68-3.14; number of cases in this category: n = 7). Our findings suggest that multiple miscarriages are associated with an increased risk of epithelial ovarian cancer, possibly through a shared cluster of etiological factors or a common underlying pathology. These findings should be interpreted with caution as this is the first study to show this association and given the small number of cases in the highest exposure categories.

While the risk of ovarian cancer clearly reduces with each full-term pregnancy, the effect of incomplete pregnancies is unclear. We investigated whether incomplete pregnancies (miscarriages and induced abortions) are associated with risk of epithelial ovarian cancer. This observational study was carried out in female participants of the European Prospective Investigation into Cancer and Nutrition (EPIC). A total of 274,442 women were followed from 1992 until 2010. The baseline questionnaire elicited information on miscarriages and induced abortions, reproductive history, and lifestyle-related factors. During a median follow-up of 11.5 years, 1,035 women were diagnosed with incident epithelial ovarian cancer. Despite the lack of an overall association (ever vs. never), risk of ovarian cancer was higher among women with multiple incomplete pregnancies (HR≥4vs.0: 1.74, 95% CI: 1.20-2.70; number of cases in this category: n = 23). This association was particularly evident for multiple miscarriages (HR≥4vs.0: 1.99, 95% CI: 1.06-3.73; number of cases in this category: n = 10), with no significant association for multiple induced abortions (HR≥4vs.0: 1.46, 95% CI: 0.68-3.14; number of cases in this category: n = 7). Our findings suggest that multiple miscarriages are associated with an increased risk of epithelial ovarian cancer, possibly through a shared cluster of etiological factors or a common underlying pathology. These findings should be interpreted with caution as this is the first study to show this association and given the small number of cases in the highest exposure categories. [ABSTRACT FROM AUTHOR]