Drape estimation of blood loss is more accurate than visual estimation and may have particular utility in the developing world. Prompt detection of postpartum hemorrhage may reduce maternal morbidity and mortality in low-resource settings.

Background: Preterm birth remains a common cause of neonatal mortality with a disproportionate burden occurring in low and middle-income countries. Meta-analyses of lowdose aspirin to prevent preeclampsia suggest that the incidence of preterm birth may be decreased, particularly if initiated before 16 weeks. Methods: We conducted a multi-country randomized, double masked trial of aspirin (81 mg) daily compared to placebo initiated between 6 weeks and 0 days of pregnancy and 13 weeks and 6 days of pregnancy in nulliparous women. Prior to randomization, ultrasound confirmed the gestational age and presence of a singleton viable pregnancy. The primary outcome was preterm birth, defined as delivery at or after 20 weeks and prior to 37 weeks gestational age. Results: A total of 11,976 women in 6 countries (India, Guatemala, Pakistan, Kenya, Zambia, Democratic Republic of Congo) were randomly assigned to aspirin (5,990 women) or placebo (5,986 women). Preterm birth occurred in 11.6% of women randomized to aspirin and 13.1% randomized to placebo (RR, 0.89; 95% CI, 0.81 to 0.98). Women who took aspirin were also less likely to deliver before 34 weeks gestation (3.3% vs 4.0%; RR, 0.75; 95%CI, 0.61 to 0.93) or experience perinatal mortality (45.7/1000 vs 53.6/1000; RR, 0.86; 95%CI, 0.73 to 1.00). Adverse maternal events were similar between the two groups. Conclusions: In nulliparous women with singleton pregnancies, low dose aspirin initiated between 6 weeks and 0 days and 13 weeks and 6 days results in lower rates of preterm delivery before 37 weeks and before 34 weeks.

Objective To describe the association of maternal anaemia with maternal, fetal, and neonatal outcomes. Design Prospective cohort study. Setting Rural India and Pakistan. Population Pregnant women residing in the study catchment area. Methods We performed an analysis of a prospective pregnancy registry in which haemoglobin is commonly obtained as well as maternal, fetal, and neonatal outcomes for 42 days post-delivery. Women 40 years or older who delivered before 20 weeks or had a haemoglobin level of <3.0 g/dl were excluded. Our primary exposure was maternal anaemia, which was categorised in keeping with World Health Organization criteria based on a normal (≥11 g/dl), mild (>10–10.9 g/dl), moderate (7–9.9 g/dl) or severe (<7 g/dl). haemoglobin level. The primary maternal outcome was maternal death, the primary fetal outcome was stillbirth, and the primary neonatal outcome was neonatal mortality <28 days. Results A total of 92 247 deliveries and 93 107 infants were included, of which 87.8% were born to mothers who were anaemic (mild 37.9%, moderate 49.1%, and severe 0.7%). Maternal mortality (number per 100 000) was not associated with anaemia: normal 124, mild 106, moderate 135, and severe 325 (P = 0.64). Fetal and neonatal mortality was associated with severe anaemia: stillbirth rate (n/1000)—normal 27.7, mild 25.8, moderate 30.1, and severe 90.9; P < 0.0001; 28-day neonatal mortality (n/1000)—normal 24.7, mild 22.9, moderate 28.1, and severe 72.6 (P < 0.0001). Severe maternal anaemia was also associated with low birthweight (<2500 and <1500 g), preterm birth, and postpartum haemorrhage. Conclusion Severe maternal anaemia is associated with higher risks of poor maternal, fetal, and neonatal outcomes but other degrees of anaemia are not. Interventions directed at preventing severe anaemia in pregnant women should be considered.

Highlights As implemented, the CLIP intervention did not improve the primary composite outcome. ASHAs and ANMs were able to undertake all aspects of the mobile health app-guided visits. Women could not be reached in their communities as frequently as planned. Eight or more POM-guided contacts were associated with fewer stillbirths supporting WHO guidance. Community-level interventions are unlikely to improve outcomes without enhanced facility care.

IMPORTANCEThe overwhelming majority of fetal and neonatal deaths occur in low-and middleincome countries. Fetal and neonatal risk assessment tools may be useful to predict the risk of death. OBJECTIVE To develop risk prediction models for intrapartum stillbirth and neonatal death.