PREVENTING MATERNAL MORTALITY FROM OBSTRUCTED LABOR

项目总结/摘要 难产占全世界孕产妇死亡总数的3-8%，在许多国家， 就像30年前一样流行。头盆不称（CPD）是一种不适当的大小产妇 骨盆，与胎儿头部相比，它阻止胎儿在分娩过程中通过盆腔。 分娩，导致难产。CPD相关的难产需要通过剖腹产（C/S）分娩。 CPD在像埃塞俄比亚这样的地方特别普遍，那里的女孩身材矮小，营养不良，结婚 在年轻时，或者在骨盆完全发育之前怀孕。埃塞俄比亚孕产妇和围产期死亡率 是世界上最高的国家之一7，11%的孕产妇死亡是由于难产。的后果 CPD相关的梗阻性分娩（在没有C/S）往往是孕产妇和/或围产期死亡率或发病率; 例如，在一个实施例中，每250名妇女中就有1名报告患有产科瘘管病。埃塞俄比亚在吸收艾滋病毒/艾滋病方面 在过去几年中，产前护理和在保健设施分娩的比率有所提高;然而，产前护理/分娩比率仍然很低。 (1.9由于缺乏基础设施和外科专业知识，以及没有及时评估风险最大的患者， 妈妈们在埃塞俄比亚的公共卫生部门，产妇护理和分娩是免费提供的， 为高危孕妇提供转移、住宿和护理服务。有一个 迫切需要开发并转化为临床使用，安全，负担得起，易于使用，可接受和准确 方法，以确定母亲在高风险的梗阻性分娩，在分娩开始之前，所以高风险的母亲可以 转移到C/S是可行选择的设施。本提案的目的是（i）验证风险评分 在一个充分把握度的样本中，在更广泛的胎龄范围（12-42周）和6个部落中， 埃塞俄比亚地区，（ii）测试引入低成本智能手机超声波的可行性，以改善 埃塞俄比亚的持续专业发展风险评估，㈢量化拟议干预措施的使用背景， 这些持续专业发展风险评估工具的易用性和受益人的可接受性，以及（iv）确定和克服 继续职业发展风险评估和高风险母亲到基层医院的转诊后续行动的障碍，其中C/S是 一个选择这些目标的成功实现将提供充分的验证、可用性、可接受性， 这些新型CPD风险评估工具在埃塞俄比亚的临床使用数据，并将这一创新很好地定位于 更广泛的临床研究，以评估在埃塞俄比亚初级卫生保健部门整合这些工具的影响 并最终纳入常规产前护理。此外，在其他国家进行的适度验证研究 具有高CPD负担（例如，尼日利亚、印度），这一创新可以转化为在储蓄方面产生更广泛的影响 出生时就有生命。

PROJECT SUMMARY / ABSTRACT Obstructed labor accounts for 3-8% of all maternal deaths worldwide and, in many countries, is almost as prevalent today as it was 30 years ago. Cephalopelvic disproportion (CPD) is an inadequate size of the maternal pelvis, compared to the fetal head, which prevents the fetus from passing through the pelvic cavity during delivery, causing obstructed labor. CPD-related obstructed labor requires delivery via Caesarean section (C/S). CPD is especially prevalent in places like Ethiopia, where girls are small in stature, grow up malnourished, marry at a young age, or become pregnant before the pelvis is fully grown. Maternal and perinatal mortality in Ethiopia are among the highest in the world 7 and, 11% of maternal deaths are due to obstructed labor. The consequence of CPD-related obstructive labor (in the absence of C/S) is often maternal and/or perinatal mortality or morbidity; e.g., 1 in 250 women report having an obstetric fistula. Ethiopia has showing tremendous increases in the uptake of antenatal care and deliveries in health facilities over the past few years; yet, the rate of C/S remains very low (1.9%) due to the lack of infrastructure and surgical expertise and lack of timely assessment of the most at-risk mothers. In the Ethiopian public health sector, maternal care and delivery is provided at no cost, including making provisions for high-risk pregnancies to be transferred, lodged, and cared for to appropriate facilities. There is a pressing need to develop, and translate to clinical use, safe, affordable, easy-to-use, acceptable, and accurate methods to identify mothers at high-risk of obstructed labor, before the onset of labor, so high-risk mothers can be transferred to facilities where C/S is a viable option. The purpose of this proposal is to (i) validate risk scores over an adequately powered sample, over a broader range of gestational ages (12-42 weeks) and over 6 tribal regions in Ethiopia, (ii) to test the feasibility of introducing a low-cost, smartphone enabled ultrasound to improve CPD risk assessment in Ethiopia, (iii) quantify the context of use for the proposed intervention and improve ease-of-use and beneficiary acceptability of these CPD risk assessment tools, and (iv) identify and overcome barriers to CPD risk assessment and referral follow-up of high-risk mothers to primary hospitals, where C/S is an option. Successful realization of these aims will provide adequate validation, usability, acceptability, and first clinical use data for these novel CPD risk assessment tools in Ethiopia and position this innovation well for a broader clinical study to assess impact of integrating these tools across the primary health care sector in Ethiopia and, ultimately, integration into routine antenatal care. Further, with modest validation studies in other countries with a high CPD burden (e.g., Nigeria, India), this innovation can be translated to have a broader impact in saving lives at birth.