en ● Health Systems مقاله اصيل پژوهشي Orginal Article <div style="text-align: justify;"><span style="font-size:11pt"><span style="line-height:normal"><span style="font-family:Calibri,sans-serif"><b><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:black">Background: </span></span></span></b><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:black">Understanding service sustainability and outcomes in outreach facilities is crucial. </span></span></span></span></span></span><br> <span style="font-size:11pt"><span style="line-height:normal"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:black">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.</span></span></span></span></span></span><br> <span style="font-size:11pt"><span style="line-height:normal"><span style="font-family:Calibri,sans-serif"><b><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:black">Methods: </span></span></span></b><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:black">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. </span></span></span></span></span></span><br> <span style="font-size:11pt"><span style="line-height:normal"><span style="font-family:Calibri,sans-serif"><b><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:black">Results:</span></span></span></b> <span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:black">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 &ge;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. </span></span></span></span></span></span><br> <span style="font-size:11pt"><span style="line-height:normal"><span style="font-family:Calibri,sans-serif"><b><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:black">Conclusions:</span></span></span></b> <span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:black">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.</span></span></span></span></span></span></div> Birth centers, Natural childbirth, Outcome Assessment, Health Care 5 5 http://jrh.gmu.ac.ir/browse.php?a_code=A-10-2868-1&slc_lang=en&sid=1 Zahra Moudi zz_moudi@yahoo.com 1 100319475328460048451 Yes Pregnancy Health Research Center, Zahedan University of Medical Sciences, Zahedan, Iran Sedighe Share Mollashahi sedighe.mollashahi@gmail.com 2 100319475328460048452 No Pregnancy Health Research Center, Zahedan University of Medical Sciences, Zahedan, Iran