{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T14:30:40Z","timestamp":1787841040452,"version":"build-2784847793"},"reference-count":21,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"9","license":[{"start":{"date-parts":[[2025,9,1]],"date-time":"2025-09-01T00:00:00Z","timestamp":1756684800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-sa\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:title>\n                    A\n                    <jats:sc>BSTRACT<\/jats:sc>\n                  <\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>During the intra-partum period, high-risk pregnancies are particularly susceptible, and without proper management, they can escalate into maternal deaths or severe complications known as maternal near-misses. Despite the availability of various national guidelines aimed at managing these high-risk situations, adherence to these protocols is notably low among mothers with high-risk intra-partum conditions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives:<\/jats:title>\n                    <jats:p>This study aims to evaluate the compliance with recommended guidelines when referring high-risk pregnancies during labour, particularly in the challenging regions of the Sunderbans.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>A cross-sectional, descriptive epidemiological study with convergent parallel approach of mixed method design was conducted at the Diamond Harbour Government Medical College Hospital\u2019s labour ward.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>The most prevalent condition among high-risk intra-partum cases was pregnancy-induced hypertension (22%), followed by anaemia (13%). While referral linkages were established for most patients (77.7%), over half (52.1%) did not receive any pre-referral treatment. Multivariate analysis revealed that mothers older than 35 years (AOR 2.28), those with a poor obstetric history (AOR 3.07), and those who were not seen by doctors (AOR 5.02) were more likely to miss out on pre-referral treatments. The study identified several key reasons for these gaps, including lack of unavailability of trained manpower, poor health communications, lack of specialised service availability and motivational issues of health care workers.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Most instances where standard treatment guidelines were not followed can be traced back to issues within health service delivery. These issues could potentially be rectified with targeted structural and administrative interventions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/jfmpc.jfmpc_431_25","type":"journal-article","created":{"date-parts":[[2025,9,27]],"date-time":"2025-09-27T21:01:04Z","timestamp":1759006864000},"page":"3816-3822","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Compliance to recommended intra-partum management protocols of high-risk pregnancies among mothers in the Sunderbans: A mixed method study"],"prefix":"10.4103","volume":"14","author":[{"given":"Sumanta","family":"Chakraborty","sequence":"first","affiliation":[{"name":"Department of Community Medicine, Diamond Harbour Government Medical College, West Bengal, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saumen Kumar","family":"De","sequence":"additional","affiliation":[{"name":"Department of Physical Medicine and Rehabilitation, Nil Ratan Sircar Medical College, West Bengal, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Disha","family":"Tibrewal","sequence":"additional","affiliation":[{"name":"Department of Community Medicine, Diamond Harbour Government Medical College, West Bengal, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2025,9,29]]},"reference":[{"key":"R2-20251009","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1177\/1753495X16686287","article-title":"Strategies to reduce the global burden of direct maternal deaths","volume":"10","author":"von Dadelszen","year":"2017","journal-title":"Obst Med"},{"key":"R4-20251009","year":"2021","journal-title":"InEnding preventable maternal mortality (EPMM): a renewed focus for improving maternal and newborn health and well-being"},{"key":"R5-20251009","doi-asserted-by":"crossref","first-page":"e83331","DOI":"10.1371\/journal.pone.0083331","article-title":"Maternal mortality in India: Causes and healthcare service use based on a nationally representative survey","volume":"9","author":"Montgomery","year":"2014","journal-title":"PLoS One"},{"key":"R6-20251009","doi-asserted-by":"crossref","first-page":"e0000441","DOI":"10.1371\/journal.pgph.0000441","article-title":"Estimates and correlates of district-level maternal mortality ratio in India","volume":"2","author":"Goli","year":"2022","journal-title":"PLOS global public health."},{"key":"R7-20251009","first-page":"2279","article-title":"Prevalence of high risk pregnancy in rural Dharwad","volume":"14","author":"Kumar","year":"2015","journal-title":"IOSR J Dent Med Sci"},{"key":"R8-20251009","doi-asserted-by":"crossref","first-page":"2814","DOI":"10.4103\/jfmpc.jfmpc_402_19","article-title":"Study of maternal outcome in referral obstetric cases in a tertiary care centre","volume":"8","author":"Jakhar","year":"2019","journal-title":"J Family Med Prim Care"},{"key":"R9-20251009","first-page":"711","article-title":"Obstetric referrals: Scenario at a primary health centre in Gujarat","volume":"3","author":"Patel","year":"2012","journal-title":"Natl J Community Med"},{"key":"R10-20251009","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1111\/birt.12160","article-title":"Intrapartum referral from primary to secondary care in the Netherlands: A retrospective cohort study on management of labor and outcomes","volume":"42","author":"Perdok","year":"2015","journal-title":"Birth"},{"key":"R11-20251009","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1186\/1471-2393-14-159","article-title":"Delays in receiving obstetric care and poor maternal outcomes: Results from a national multicentre cross-sectional study","volume":"14","author":"Pacagnella","year":"2014","journal-title":"BMC Pregnancy Childbirth"},{"key":"R12-20251009","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1186\/s12884-018-1751-z","article-title":"The effect of implementation strength of basic emergency obstetric and newborn care (BEmONC) on facility deliveries and the met need for BEmONC at the primary health care level in Ethiopia","volume":"18","author":"Tiruneh","year":"2018","journal-title":"BMC Pregnancy Childbirth"},{"key":"R13-20251009","doi-asserted-by":"crossref","first-page":"3490","DOI":"10.18203\/2394-6040.ijcmph20193477","article-title":"Adherence to recommended intra-partum guidelines of high risk pregnancies: A study in North Bengal Medical College, Darjeeling district, West Bengal, India","volume":"6","author":"Chakraborty","year":"2019","journal-title":"Int J Community Med Public Health"},{"key":"R14-20251009","doi-asserted-by":"crossref","first-page":"204","DOI":"10.4103\/jiaphd.jiaphd_123_23","article-title":"Updated B. 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