Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, Canada.
Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique.
BMC Pregnancy Childbirth. 2023 Oct 23;23(1):748. doi: 10.1186/s12884-023-06055-w.
The Three Delays Framework was instrumental in the reduction of maternal mortality leading up to, and during the Millennium Development Goals. However, this paper suggests the original framework might be reconsidered, now that most mothers give birth in facilities, the quality and continuity of the clinical care is of growing importance.
The paper explores the factors that contributed to maternal deaths in rural Pakistan and Mozambique, using 76 verbal autopsy narratives from the Community Level Interventions for Pre-eclampsia (CLIP) Trial.
Qualitative analysis of these maternal death narratives in both countries reveals an interplay of various influences, such as, underlying risks and comorbidities, temporary improvements after seeking care, gaps in quality care in emergencies, convoluted referral systems, and arrival at the final facility in critical condition. Evaluation of these narratives helps to reframe the pathways of maternal mortality beyond a single journey of care-seeking, to update the categories of seeking, reaching and receiving care.
There is a need to supplement the pioneering "Three Delays Framework" to include focusing on continuity of care and the "Four Critical Connection Points": (1) between the stages of pregnancy, (2) between families and health care workers, (3) between health care facilities and (4) between multiple care-seeking journeys.
NCT01911494, Date Registered 30/07/2013.
三延误框架在减少孕产妇死亡方面发挥了重要作用，无论是在千年发展目标之前还是期间。然而，本文认为，由于大多数产妇都在医疗机构分娩，临床护理的质量和连续性变得越来越重要，因此可能需要重新考虑最初的框架。
本文使用来自社区层面子痫前期干预试验（CLIP 试验）的 76 份死因推断叙述，探讨了导致巴基斯坦和莫桑比克农村地区孕产妇死亡的因素。
对这两个国家的孕产妇死亡叙述进行定性分析，揭示了各种因素的相互作用，如潜在风险和合并症、寻求护理后的暂时改善、紧急情况下护理质量的差距、复杂的转诊系统以及最终到达危急设施的情况。对这些叙述的评估有助于重新构建孕产妇死亡的途径，超越单一的寻求护理的旅程，更新寻求、到达和接受护理的类别。
有必要补充开创性的“三延误框架”，包括关注护理的连续性和“四个关键连接点”：（1）妊娠阶段之间，（2）家庭和医疗保健工作者之间，（3）医疗保健设施之间，以及（4）多个寻求护理旅程之间。
NCT01911494，注册日期 2013 年 7 月 30 日。
