The global impact of life-saving medical devices is directly related to their availability. Access may be limited by cost, availability, or lack of information regarding effectiveness and safety. Addressing the inequity in access requires concerted effort from device developers, the research community, global agencies and professional organisations. We discuss, with examples, three strategies to promote equity: low-cost, purpose-built innovation, improvisation and off-label use. First, developing simple, safe and low-cost innovative devices can be an effective way of increasing global access. For example, the BabySaver Kit facilitates intact-cord neonatal bedside resuscitation. Re-usability is an important design feature for both cost and environment, exemplified by the MaternaWell tray for blood loss monitoring after birth. A second strategy is improvisation using commonly available hospital items. This can extend device availability into settings where purpose-designed devices are unavailable or unaffordable. Examples include the use of condoms or glove balloons for uterine balloon tamponade (UBT) to treat postpartum haemorrhage (PPH), elastic catheters for uterine tourniquet, and plastic tubing for posterior axilla sling traction in shoulder dystocia. However, the lack of systematically developed evidence and governance approvals can lead to wide variation in training, technique, and device specifications. Finally, some of these quality issues are addressed by using approved medical devices ‘off-label.’ However, they can have similar problems of variation in technique and depend on the uncoordinated efforts of researchers and clinicians to generate an evidence base. Examples include the Foley catheter for labour induction and the Levin stomach tube for suction tube uterine tamponade for PPH. WHO has pathways to facilitate global access to important public health device innovations. Global agencies and professional organisations also have a major role to play in providing co-ordination, platforms for data sharing, practice guidelines, instructions for use on off-label devices and robust data on their safety and effectiveness.
To conduct a pilot study evaluating the acceptability of pregnancy loss nomenclature among people with recent lived experience and make recommendations for UK mass communication.
Electronic internet-based questionnaire.
UK.
Service users who accessed UK healthcare for > 1 experience(s) of pregnancy loss between 2021 and 2024 (n = 391).
Descriptive and inferential statistics.
Acceptability ratings for pregnancy loss nomenclature used diagnostically in UK healthcare settings.
Much nomenclature currently in use in UK pregnancy loss care was rated ‘unacceptable’ by a majority of study participants. Spontaneous abortion, incompetent cervix, and cervical incompetence were among the terminology rated as ‘unacceptable’ by > 80.0% of the respondents rating terms for the process of loss. In contrast, pregnancy loss and ectopic pregnancy were rated ‘acceptable’ by > 80.0% of respondents. As nomenclature for pregnancy loss outcomes, products, contents of the womb/uterus, and tissue were rated ‘unacceptable’ by > 80.0% of respondents. Baby and ‘their given name’ were rated ‘acceptable’ by > 80.0% of respondents across all gestational age brackets. Some terminology elicited mixed acceptability ratings.
Some pregnancy loss nomenclature attracted consensus acceptability or unacceptability ratings for respondents. The data inform evidence-based recommended alternatives, which should be adopted for mass communications relating to pregnancy loss.
To investigate the long-term morbidity experienced by women with a history of severe maternal morbidity (SMM).
Prospective population-based cohort study.
A tertiary medical centre.
All women who experienced SMM between 2013 and 2018 and a matched comparison group without SMM.
SMM was defined as maternal admission to the intensive care unit during the delivery hospitalisation. Women with SMM were matched 1:1 to controls based on mode and year of delivery. Multivariable Cox proportional hazards regression models were used to assess the adjusted risks of long-term diagnoses and hospitalisations, controlling for sociodemographic and clinical characteristics.
Long-term incidence of morbidities and hospitalisations.
A total of 288 women were included in the study, with a follow-up ranging from 6 to 11 years following the index pregnancy. Compared to women with no SMM in the index pregnancy, the SMM group demonstrated a significantly higher risk of cardiovascular and endocrine morbidities (adjusted HR: 4.01, 95% CI: 2.03–7.90 and 2.17; 95% CI: 1.24–3.79, respectively). Additionally, women with SMM in the index pregnancy had higher rates of SMM-related hospitalisations (adjusted HR: 1.90, 95% CI: 1.10–3.29), all-cause hospitalisations (adjusted HR: 2.21, 95% CI: 1.36–3.58) and hospitalisations within the first year following the index pregnancy (adjusted HR: 4.94, 95% CI: 1.06–23.13).
Women with SMM require vigilant multidisciplinary medical surveillance following discharge from their delivery hospitalisation. The occurrence of SMM may serve as a warning sign of significant long-term health risks.
To explore whether women experiencing homelessness during pregnancy have higher risks of adverse pregnancy outcomes compared to housed women.
Population-based retrospective cohort study using national electronic hospital records.
Maternity services across English NHS hospitals.
Women giving birth at gestational age ≥ 24 weeks from January 1, 2013 to March 31, 2023.
Data were obtained from the English National Hospital Episode Statistics Admitted Patient Care database. Poisson regression models compared outcomes for women identified as homeless to housed women, adjusting for age, parity, ethnicity, year and pre-existing medical conditions.
Severe maternal morbidity (SMM), preterm birth (< 37 and < 34 weeks), and low birth weight (< 2500 g).
Among 3 349 601 women giving birth, 3301 (0.1%) experienced homelessness. Rates and adjusted risk ratios (aRR) comparing homeless to housed women were: SMM 2.5% versus 1.6% (aRR 1.28, 95% CI 1.02–1.59); preterm birth 11.8% versus 5.9% (aRR 1.88, 95% CI 1.69–2.08); and small for gestational age 9.0% versus 4.8% (aRR 1.56, 95% CI 1.38–1.76). Stratified by ethnicity, White homeless women had the highest risk for preterm birth and small for gestational age, while Asian homeless women showed the greatest risk for SMM, compared to White housed women.
Homelessness recorded during pregnancy or at birth is associated with poorer maternal and infant outcomes. Interventions focusing on housing stability are key. Future research should explore housing dynamics beyond homelessness, including frequent moves and overcrowding, requiring detailed perinatal housing data.
To determine risks of caesarean section (CS) and instrumental deliveries, including CS on individual request, in birthing people with mental disorders, overall and according to indications (i.e., Robson group).
Register-based total population study.
Record-linkage of administrative and health data registers.
A total of 178,069 people with a delivery during 2014–2020 in Stockholm County.
Mental disorders in birthing people were identified from health care registers as at least one recorded diagnosis according to ICD-10, and categorised as non-psychotic mood and anxiety disorders, severe, psychotic neurodevelopmental, and other mental disorders. Binary and multinomial regression analyses were used to estimate adjusted odds ratios (aOR) with 95% confidence intervals (95% CI), overall and stratified by Robson group.
Overall mode of delivery (non-instrumental vaginal, instrumental vaginal, elective and emergency CS) and CS on individual request (yes/no).
In total, 143 483 individuals were included in the analysis. Among them, 10.06% had elective caesarean section (CS), 10.89% non-elective CS, 5.61% instrumental delivery, and 5.70% CS on maternal request. The adjusted odds ratio of elective CS (aOR 1.54, 95% CI 1.49–1.60), emergency CS (aOR 1.24, 95% CI 1.20–1.28), and CS on request (aOR 2.05, 95% CI 1.96–2.14) was increased among birthing people with mental disorders. The associations were of similar magnitudes regardless of the type of mental disorder, but particularly pronounced among nulliparous birthing people with full-term, single, cephalic delivery (Robson group 1–2).
Mental disorders in birthing people are associated with an increased risk of caesarean section, both overall and on birthing person request. There may be unmet needs for obstetric care in birthing people with mental disorders.
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