Beth Payne and colleagues use a risk prediction model, the Pre-eclampsia Integrated Estimate of RiSk (miniPIERS) to help inform the clinical assessment and triage of women with hypertensive disorders of pregnancy in low-resourced settings. Please see later in the article for the Editors' Summary

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Objective: To assess the incremental value of blood oxygen saturation (SpO 2 ) as a predictor in the miniPIERS model, a risk prediction model for adverse outcomes among women with a diagnosis of hypertensive disorder of pregnancy (HDP) in lowresourced settings .Methods: Using data from a prospective cohort including 852 women admitted to hospital for a HDP, the association between SpO 2 and adverse maternal outcome was assessed using logistic regression . The miniPIERS model was recalibrated and extended to include SpO 2 . The incremental value of adding SpO 2 to the model was measured using a net reclassification index (NRI), sensitivity, specificity, positive and negative predictive values, and likelihood ratios .Results: SpO 2 of < 93% was associated with a 30-fold increase in risk (95% CI 14 to 68) of adverse maternal outcome compared to women with SpO 2 > 97% . After recalibration and extension, the miniPIERS model including SpO 2 (vs . not including SpO 2 ) had improved sensitivity (32 .8% vs . 49 .6%) at the cost of minimally decreased specificity (91.5% vs. 96.2%) with a NRI of 0.122. Conclusion:SpO 2 is a significant independent predictor of risk in women with a HDP . Adding SpO 2 to the miniPIERS model improved the model's ability to correctly identify high-risk patients who would benefit most from interventions. RésuméObjectif : Évaluer la valeur cumulative de la saturation en oxygène (SaO 2 ) à titre de facteur prédictif dans le cadre du modèle miniPIERS, soit un modèle de prévision des risques en ce qui concerne les issues indésirables chez les femmes ayant obtenu un diagnostic de trouble hypertensif de la grossesse (THG) dans des milieux qui ne disposent que de faibles ressources . Méthodes

Refusal to participate and drop out from the research program are two significant factors hindering the smooth flow of a study. In Pakistan, the major reason for the refusal by the protocol-eligible pregnant women for participating in a research program is the unwillingness of the family members.

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Objective: To explore the experiences and perceptions of midwives practising the midwifery-led care model at two private facilities of women and children hospital in Karachi, Pakistan. Methods: The descriptive qualitative data was collected through semi-structured questionnaires with 10 midwives. Results: The findings of the study revealed one theme and four related categories. The theme of the study emerged as ‘struggling to be a professional midwife’ and the related four categories were: (i) asking to perform within the full scope of practice, (ii) obstetricians’ reliance and trust in midwives' expertise, (iii) raising concerns about expensive midwifery services, and (iv) encountering barriers to practise midwifery as independent practitioners. Conclusion: Midwives face some challenges practising the midwifery-led care model such as lack of visibility in society, low salaries and increased workload due to the shortage of staff. Lack of higher education was also highlighted by the midwives as they have no opportunities for career growth. This study will increase midwives' autonomous role and decision-making in the clinical setting.

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Cite this article as: Payne et al.: Designing an evidence-based mobile health decision aid for the management of hypertensive disorders of pregnancy (HDP) in low-resourced settings.