ObjectiveTo field test a standardized instrument to measure nonsevere morbidity among antenatal and postpartum women.MethodsA cross‐sectional study was conducted in Jamaica, Kenya, and Malawi (2015–2016). Women presenting for antenatal care (ANC) or postpartum care (PPC) were recruited if they were at least 28 weeks into pregnancy or 6 weeks after delivery. They were interviewed and examined by a doctor, midwife, or nurse. Data were collected and securely stored electronically on a WHO server. Diagnosed conditions were coded and summarized using ICD‐MM.ResultsA total of 1490 women (750 ANC; 740 PPC) averaging 26 years of age participated. Most women (61.6% ANC, 79.1% PPC) were healthy (no diagnosed medical or obstetric conditions). Among ANC women with clinical diagnoses, 18.3% had direct (obstetric) conditions and 18.0% indirect (medical) problems. Prevalences among PPC women were lower (12.7% and 8.6%, respectively). When screening for factors in the expanded morbidity definition, 12.8% (ANC) and 11.0% (PPC) self‐reported exposure to violence.ConclusionNonsevere conditions are distinct from the leading causes of maternal death and may vary across pregnancy and the puerperium. This effort to identify and measure nonsevere morbidity promotes a comprehensive understanding of morbidity, incorporating maternal self‐reporting of exposure to violence, and mental health. Further validation is needed.

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Background: Evidence on recent trends regarding the impact and cost-benefits of ultrasound in resource-constrained settings is limited. This study presents a systematic review to determine recent trends in the utility and applicability of ultrasound use in low and middle income countries (LMIC). The review includes characterizing and evaluating trends in (1) the geographic and specialty specific use of ultrasound in LMICs, (2) the innovative applications and the accompanying research findings, and (3) the development of associated educational and training programs. Methods: The electronic databases Medline OVID, EMBASE, and Cochrane were searched from 2010 to 2018 for studies available in English, French, and Spanish. Commentaries, opinion articles, reviews and book chapters were excluded. Two categories were created, one for reported applications of ultrasound use in LMICs and another for novel ultrasound studies. Results: A total of 6,276 articles were identified and screened, 4,563 studies were included for final review. 287 studies contained original or novel applications of ultrasound use in LMICs. Nearly 70% of studies involved ultrasound usage originating from Southeast Asia and sub-Saharan Africa, the latter being the region with the highest number of innovative ultrasound use. Educational studies, global collaborations, and funded studies were a substantial subset of overall ultrasound research. Our findings are limited by the lack of higher quality evidence and limited number of randomized clinical trials reported. Conclusion/Global Health Implications: Our systematic literature review of ultrasound use in LMICs demonstrates the growing utilization of this relatively low-cost, portable imaging technology in low resource settings. Key words: • Ultrasound • Ultrasono graph y • Echocardiogram • LMIC • Low resource • Global health • Systematic review   Copyright © 2020 Stewart et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited

Objective To determine the impact of Centering Pregnancy-based group prenatal care for Hispanic gravid diabetics on pregnancy outcomes and postpartum follow-up care compared to those receiving traditional prenatal care. Methods A cohort study was performed including 460 women diagnosed with gestational diabetes mellitus (GDM) who received traditional or Centering Pregnancy prenatal care. The primary outcome measured was completion of postpartum glucose tolerance testing. Secondary outcomes included postpartum visit attendance, birth outcomes, breastfeeding, and initiation of a family planning method. Results 203 women received Centering Pregnancy group prenatal care and 257 received traditional individual prenatal care. Women receiving Centering Pregnancy prenatal care were more likely to complete postpartum glucose tolerance testing than those receiving traditional prenatal care, (83.6 vs. 60.7 %, respectively; p < 0.001), had a higher rate of breastfeeding initiation (91.0 vs. 69.4 %; p < 0.001), had higher rates of strictly breastfeeding at their postpartum visit (63.1 vs. 46.3 %; p = 0.04), were less likely to need medical drug therapy compared to traditional prenatal care (30.2 vs. 42.1 %; p = 0.009), and were less likely to undergo inductions of labor (34.5 vs. 46.2 %; p = 0.014). When only Hispanic women were compared, women in the Centering group continued to have higher rates of breastfeeding and completion of postpartum diabetes screening. Conclusion for Practice Hispanic women with GDM who participate in Centering Pregnancy group prenatal care may have improved outcomes.

ObjectiveTo assess the scores of postpartum women using the WHO Disability Assessment Schedule 2.0 36‐item tool (WHODAS‐36), considering different morbidities.MethodsSecondary analysis of a retrospective cohort of women who delivered at a referral maternity in Brazil and were classified with and without severe maternal morbidity (SMM). WHODAS‐36 was used to assess functioning in postpartum women. Percentile distribution of total WHODAS score was compared across three groups: Percentile (P)<10, 1090. Cases of SMM were categorized and WHODAS‐36 score was assessed according to hypertension, hemorrhage, or other conditions.ResultsA total of 638 women were enrolled: 64 had mean scores below P<10 (1.09) and 66 were above P>90 (41.3). Of women scoring above P>90, those with morbidity had a higher mean score than those without (44.6% vs 36.8%, P=0.879). Women with higher WHODAS‐36 scores presented more complications during pregnancy, especially hypertension (47.0% vs 37.5%, P=0.09). Mean scores among women with any complication were higher than those with no morbidity (19.0 vs 14.2, P=0.01). WHODAS‐36 scores were higher among women with hypertensive complications (19.9 vs 16.0, P=0.004), but lower among those with hemorrhagic complications (13.8 vs 17.7, P=0.09).ConclusionsComplications during pregnancy, childbirth, and the puerperium increase long‐term WHODAS‐36 scores, demonstrating a persistent impact on functioning among women, up to 5 years postpartum.

ObjectivesTo compare scores on the 36‐item WHO Disability Assessment Schedule 2.0 tool (WHODAS‐36) for postpartum women across a continuum of morbidity and to validate the 12‐item version (WHODAS‐12).MethodsThis is a secondary analysis of the Brazilian retrospective cohort study on long‐term repercussions of severe maternal morbidity. We determined mean, median, and percentile values for WHODAS‐36 total score and for each domain, and percentile values for WHODAS‐12 total score in postpartum women divided into three groups: “no,” “nonsevere,” and “severe” morbidities.ResultsThe WHODAS‐36 mean total scores were 11.58, 18.31, and 19.19, respectively for no, nonsevere, and severe morbidity. There was a dose‐dependent effect on scores for each domain of WHODAS‐36 according to the presence and severity of morbidity. The diagnostic validity of WHODAS‐12 was determined by comparing it with WHODAS‐36 as a “gold standard.” The best cut‐off point for diagnosing dysfunctionality was the 95th percentile.ConclusionThe upward trend of WHODAS‐36 total mean value scores of women with no morbidity compared with those with morbidity along a severity continuum may reflect the impact of morbidity on postpartum functioning.

ObjectiveTo validate the WHO Disability Assessment Schedule 2.0 (WHODAS 2.0) 12‐item tool against the 36‐item version for measuring functioning and disability associated with pregnancy and the occurrence of maternal morbidity.MethodsThis is a secondary analysis of the Brazilian retrospective cohort study on long‐term repercussions of severe maternal morbidity (SMM) among women who delivered at a tertiary facility (COMMAG study). We compared WHODAS‐12 and WHODAS‐36 scores of women with and without SMM using measures of central tendency and variability, tests for instruments’ agreement (Bland‐Altman plot), confirmatory factor analysis (CFA), and Cronbach alpha coefficient for internal consistency.ResultsThe COMMAG study enrolled 638 women up to 5 years postpartum. Although the median WHODAS‐36 and ‐12 scores for all women were statistically different (13.04 and 11.76, respectively; P<0.001), there was a strong linear correlation between them. Furthermore, the mean difference and the differences in variance analyses demonstrated agreement of total scores between the two versions. CFA demonstrated how the WHODAS‐12 questions are divided into six previously defined factors and Cronbach alpha showed good internal consistency.Conclusion WHODAS‐12 demonstrated agreement with WHODAS‐36 for total score and was a good instrument for screening functioning and disability among postpartum women, with and without SMM.

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