Background Obstructed labor is one of the five major causes of maternal mortality and morbidity in developing countries. In Ethiopia, it accounts for 19.1% of maternal death. The current review aimed to assess maternal and perinatal outcomes of obstructed labor in Ethiopia. Methods Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was followed for this systematic review and meta-analysis. A literature search was made using PubMed/MEDLINE, CINAHL, Summon country-specific search, and Cochrane Libraries’ online databases. Search terms were adverse outcome, obstructed labor, maternal outcome, fetal outcome, and Ethiopia. The Newcastle-Ottawa scale (NOS), based on a star scoring system, was used to assess the quality of the included studies. The meta-analysis was conducted using STATA 16 software. The pooled prevalence of an adverse maternal outcome, fetal outcome, and association between adverse outcome and obstructed labor was calculated using a random-effects model. Egger’s test and funnel plot were used to evaluate publication bias. Result Eighty-seven studies were included in this review, with an overall sample size of 104259 women and 4952 newborns. The pooled incidence of maternal death was estimated to be 14.4% [14.14 (6.91–21.37). The pooled prevalence of uterine rupture and maternal near-miss was 41.18% (95% CI: 19.83, 62.54) and 30.5% [30.5 (11.40, 49.59) respectively. Other complications such as postpartum hemorrhage, sepsis, obstetric fistula, hysterectomy, bladder injury, cesarean section, and labor abnormalities were also reported. The pooled prevalence of perinatal death was 26.4% (26.4 (95% CI 15.18, 37.7). In addition, the association of obstructed labor with stillbirth, perinatal asphyxia, and meconium-stained amniotic fluid was also demonstrated. Conclusions In Ethiopia, the incidence of perinatal and maternal mortality among pregnant women with obstructed labor was high. The rate of maternal death and maternal near miss reported in this review was higher than incidences reported from high-income and most low and middle-income countries. Uterine rupture, postpartum hemorrhage, sepsis, fistula, hysterectomy, and bladder injury were also commonly reported. To improve the health outcomes of obstructed labor, it is recommended to address the three delay models: enhancing communities’ health-seeking behavior, enhancing transportation for an obstetric emergency with different stakeholders, and strengthening the capacity of health facilities to handle obstetric emergencies.

Background: Maternal stress during pregnancy has been associated with adverse pregnancy and birth outcomes. Aiming to reduce maternal stress and to improve pregnancy and birth outcomes, different relaxation interventions have been tested during pregnancy. This systematic review and meta-analysis was conducted on studies that have tested relaxation interventions to improve maternal wellbeing, and pregnancy and birth outcomes in various settings. Method: A systematic search of PubMed, EMBASE Classic + EMBASE (Ovid), MEDLINE In-Process and Non-Indexed Citations, MEDLINE Daily, and MEDLINE (Ovid), Cumulative Index to Nursing & Allied Health Plus (CINAHL via EBSCO) and Cochrane library databases was conducted to identify studies on stress reduction relaxation interventions in pregnant women. The outcomes of interest were maternal mental health (stress, anxiety, and depression), pregnancy outcomes (gestational age, labor duration and mode of delivery) and birth outcomes (birth weight, APGAR score and term or preterm delivery). Randomized controlled trials or quasi-experimental studies with stress reduction relaxation interventions during pregnancy and ever published in English globally were eligible for inclusion. Studies with interventions in high-risk pregnancies, those including psychotropic medications, or interventions at the onset of labor and delivery were excluded. All studies were screened for quality and risk of bias. We conducted meta-analyses, using random-effects models, for three outcomes for which there was sufficient information: maternal depressive symptoms, perceived maternal stress; and birth weight. Result: Nineteen studies were eligible for analysis. The studies sampled 2395 pregnant women, mostly aged between 18 and 39 years. The interventions applied were yoga therapy, music therapy, progressive muscular relaxation (PMR)/guided imagery/deep breathing exercises, mindfulness or hypnosis. The meta-analyses showed that the interventions were effective in improving maternal depressive symptoms (-2.5 points, [95% confidence interval (CI) -3.6, -1.3]) and stress symptoms (-4.1 points, [95% CI -8.1, -0.1]) during pregnancy. There was no effect of the interventions overall on birth weight (45 g, 95% CI -56, 146); however, PMR in two studies increased birth weight (181 g, 95% CI 25, 338) whereas music therapy and yoga had no benefit. Narrative syntheses of outcomes that were not amenable to meta-analysis indicated beneficial effects of music interventions on APGAR score (n=4 studies) and gestational age at birth (n=2 studies). Interventions were also reported to significantly increase spontaneous mode of delivery (n=3 studies) and decrease the rate of instrumental virginal delivery by 5%, caesarean section by 20% and duration of labor (n=2 study). Discussion: Adverse life experience during pregnancy impairs the normal adaptive changes supposed to maintain normal homeostasis during pregnancy and results in increased risk of stress, anxiety and depression. This imbalance results in increased stress hormone in the maternal-fetal circulation which is harmful to the mother and her fetus leading for adverse pregnancy and birth outcomes. Stress reduction relaxation intervention restores the normal homeostasis in pregnancy and improves normal biological and psychological wellbeing and consequently improves pregnancy and birth outcomes.   Conclusion: In addition to benefits for mothers, relaxation interventions hold some promise for improving newborn outcomes; therefore, this approach strongly merits further research.