Volume 16, Issue 6 (Nov & Dec- In press 2026)
J Research Health 2026, 16(6): 5-5 |
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Ethics code: IR.ZAUMS.REC.1401.405
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Moudi Z, Share Mollashahi S. Trends in Maternal Referrals and Health Outcomes in Maternity Outreach Centers Serving Vulnerable Population in Zahedan, Iran: A 10-Year Comparative Analysis (2014-2023). J Research Health 2026; 16 (6) :5-5
URL: http://jrh.gmu.ac.ir/article-1-2964-en.html
URL: http://jrh.gmu.ac.ir/article-1-2964-en.html
1- Pregnancy Health Research Center, Zahedan University of Medical Sciences, Zahedan, Iran , zz_moudi@yahoo.com
2- Pregnancy Health Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
2- Pregnancy Health Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
Abstract: (10 Views)
Background: Understanding service sustainability and outcomes in outreach facilities is crucial.
This study aimed to (1) assess trends in deliveries and referral patterns at safe delivery posts (SDPs) from 2014 to 2023, (2) compare maternal outcomes related to postpartum hemorrhage (PPH) management with the previous decade, and (3) conduct a root cause analysis (RCA) of PPH-related maternal deaths.
Methods: A retrospective observational study was conducted using SDPs records from 2014 to 2023. Delivery and referral trends were analyzed using Chi-square tests and Poisson regression. Maternal outcomes of PPH were examined between the previous decade (2012-2013; n=81) and the recent period (2021-2023; n=65). RCA of maternal deaths was performed using the WHO framework.
Results: Among 32,649 low-risk women delivered in SDPs, the referral rate was 1.84% (602/32,649). PPH (25.6%) and Prolonged labor (25.4%) were the main causes of referral. Poisson regression identified PPH, prolonged labor, and hypertension as significant predictors of referral (p<0.001). In 2023, improvements were observed in IV fluid administration ≥2 liters (OR=2.06), misoprostol use (OR=2.80), and hospital admission within 60 minutes (OR=3.78) compared to 2012-2013. RCA indicated that most PPH-related deaths were preventable and linked to delayed recognition, weak referral, and poor adherence to guidelines.
Conclusions: SDPs play a key role in sustaining maternity care utilization among marginalized women. While PPH management has improved, strengthening adherence to evidence-based protocols, the referral system, and hospital preparedness is essential to further improve maternal outcomes in similar low-resource contexts.
This study aimed to (1) assess trends in deliveries and referral patterns at safe delivery posts (SDPs) from 2014 to 2023, (2) compare maternal outcomes related to postpartum hemorrhage (PPH) management with the previous decade, and (3) conduct a root cause analysis (RCA) of PPH-related maternal deaths.
Methods: A retrospective observational study was conducted using SDPs records from 2014 to 2023. Delivery and referral trends were analyzed using Chi-square tests and Poisson regression. Maternal outcomes of PPH were examined between the previous decade (2012-2013; n=81) and the recent period (2021-2023; n=65). RCA of maternal deaths was performed using the WHO framework.
Results: Among 32,649 low-risk women delivered in SDPs, the referral rate was 1.84% (602/32,649). PPH (25.6%) and Prolonged labor (25.4%) were the main causes of referral. Poisson regression identified PPH, prolonged labor, and hypertension as significant predictors of referral (p<0.001). In 2023, improvements were observed in IV fluid administration ≥2 liters (OR=2.06), misoprostol use (OR=2.80), and hospital admission within 60 minutes (OR=3.78) compared to 2012-2013. RCA indicated that most PPH-related deaths were preventable and linked to delayed recognition, weak referral, and poor adherence to guidelines.
Conclusions: SDPs play a key role in sustaining maternity care utilization among marginalized women. While PPH management has improved, strengthening adherence to evidence-based protocols, the referral system, and hospital preparedness is essential to further improve maternal outcomes in similar low-resource contexts.
Type of Study: Orginal Article |
Subject:
● Health Systems
Received: 2025/11/2 | Accepted: 2026/01/5 | Published: 2026/11/4
Received: 2025/11/2 | Accepted: 2026/01/5 | Published: 2026/11/4
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