Fetal outcome in severe maternal morbidity: Too many stillbirths

Based on the research findings, the recommendation to improve access to maternal health and reduce stillbirth rates in poor settings like The Gambia is to focus on two key areas:

1. Enhancing access to emergency obstetric care: Improving access to emergency obstetric care is crucial in preventing stillbirths. This can be achieved by increasing the number of well-equipped obstetric referral hospitals and ensuring they are adequately staffed with skilled healthcare professionals. Additionally, efforts should be made to improve transportation systems to enable pregnant women to reach these facilities in a timely manner.

2. Improving intrapartum care: Intrapartum care refers to the care provided during labor and delivery. It is important to ensure that healthcare providers are trained in managing obstetric complications effectively. This includes early recognition and management of hemorrhage, anemia, sepsis, and hypertensive pregnancy disorders. Additionally, promoting safe delivery practices and encouraging the use of cesarean sections when necessary can help reduce stillbirth rates among women with severe obstetric complications.


1. Identify the target population: Determine the specific population in The Gambia that will be the focus of the simulation. This could include pregnant women in poor settings who have limited access to maternal health services.

2. Collect baseline data: Gather data on the current stillbirth rates and access to maternal health services in the target population. This can be done through surveys, interviews, or existing data sources.

3. Define the intervention: Clearly define the two main recommendations for improving access to maternal health: enhancing access to emergency obstetric care and improving intrapartum care. Specify the key components of each recommendation, such as increasing the number of well-equipped obstetric referral hospitals or providing training for healthcare providers.

4. Develop a simulation model: Create a simulation model that incorporates the baseline data and the defined intervention. This model should simulate the impact of the recommendations on stillbirth rates in the target population. Consider factors such as the number of additional hospitals, the availability of skilled healthcare professionals, and the improvement in transportation systems.

5. Run the simulation: Implement the simulation model using appropriate software or tools. Input the baseline data and intervention parameters to simulate the impact on stillbirth rates. Run the simulation multiple times to account for variability and uncertainty.

6. Analyze the results: Analyze the output of the simulation to determine the projected impact of the recommendations on stillbirth rates. Compare the simulated stillbirth rates with the baseline data to assess the effectiveness of the intervention.

7. Interpret the findings: Interpret the results of the simulation and draw conclusions about the potential impact of the recommendations on improving access to maternal health and reducing stillbirth rates in The Gambia. Consider the limitations of the simulation and any additional factors that may influence the outcomes.

8. Communicate the findings: Present the findings of the simulation in a clear and concise manner, highlighting the potential benefits of implementing the recommendations. Share the results with relevant stakeholders, such as policymakers, healthcare providers, and community members, to facilitate informed decision-making and action.

It is important to note that this methodology is a general outline and may need to be adapted based on the specific context and available resources.