Preventing deaths from complications of labour and delivery

Abstract

The process of labour and delivery remains an unnecessary and preventable cause of death for women and babies around the world. Although rates of maternal and perinatal death are declining, there are large disparities between rich and poor countries, and sub-Saharan Africa has not seen the scale of declines shown elsewhere. In many areas, maternity services remain sparse and underequipped, with insufficient and poorly trained staff. Priorities for reducing the mortality burden are provision of safe caesarean section, prevention of sepsis, and appropriate care of women in labour in line with current best practices, appropriately and affordably delivered. A concern is that largescale recourse to caesarean delivery has its own dangers and may present new dominant causes for maternal mortality. An area of current neglect is newborn care. However, innovative training methods and appropriate technologies offer opportunities for affordable and effective newborn resuscitation and follow-up management in low-income settings.

Correlation between complications during delivery and neonatal mortality: Data analysis of Indonesia Demographic and Health Survey (IDHS) 2017

“…Sepsis can lead to increased neonatal mortality. 19 This is in line with a study finding that mothers who experienced symptoms of complications during labour with premature rupture of membranes had a higher chance of neonatal death. 20 In another study, neonates born to mothers who experienced labour complications such as prolonged labour, vaginal bleeding, and seizures, had 2 times of neonatal death compared to neonates born to mothers without labour complications.…”

Point-of-care lactate and creatinine analysis for sick obstetric patients at Queen Elizabeth Central Hospital in Blantyre, Malawi: A feasibility study

“…Thus, point-of-care testing can facilitate the effective use of a limited number of HDU beds and accelerate smooth "step-up" care for patients who deteriorate and "step-down" care for those ready to transfer to a postnatal ward. 13 While it was beyond the scope of this feasibility study to formally investigate point-of-care testing in relation to patient outcomes or to define its cost-effectiveness, evidence from a study in emergency department patients with suspected sepsis suggests that the introduction of point-of-care lactate devices reduces the time to administration of intravenous fluids, intensive care unit admission when needed, and, indeed, mortality.…”

FIGO Statement: Staffing requirements for delivery care, with special reference to low‐ and middle‐income countries

“…Similarly, for complex newborn care (such as complications of prematurity or sepsis) the professional groups involved can include pediatric neonatal specialists but also neonatal nurse practitioners or pediatric clinical officers depending on national or regional workforce arrangements. Workforce requirements for obstetric high dependency, obstetric critical care, and neonatal special care provision in larger units are beyond the scope of this document, although FIGO considers these to be essential lifesaving components of maternity care.…”