# High-risk pregnancy identification and management through antenatal, intrapartum, and postnatal care: an implementation research study protocol

## TL;DR

This study aims to improve maternal and child health by identifying and managing high-risk pregnancies through better implementation of care strategies in Rajasthan, India.

## Contribution

The study introduces a scalable, context-specific model for implementing high-risk pregnancy care strategies in low-resource settings.

## Key findings

- The study will identify barriers and facilitators in existing national programs for high-risk pregnancies.
- It will co-develop and evaluate a sustainable implementation model to improve maternal health outcomes.
- The intervention package includes training and community awareness to enhance institutional deliveries.

## Abstract

As per WHO, in 2023 more than 700 women died every day from preventable causes related to pregnancy and childbirth. Early identification and management of high-risk pregnancies are essential for improved maternal and child health outcomes and reduced mortality rates.

The study objectives are: (a) To identify the barriers and facilitators in implementing existing national programs and the continuum of care for high-risk pregnant women. (b) To co-develop, optimize and implement a context-specific, scalable, and sustainable model of implementation strategies that will help achieve population-based coverage of high-risk pregnancy identification and management. (c) To evaluate the effect of the optimised and contextualised implementation model on the key performance indicators (d) To document the processes of evolution implementation, adoption, adaptation and fidelity of the implementation model.

The study will utilize the Consolidated Framework for Implementation Research and will be implemented in Nagaur district of Rajasthan, India. The study involves formative research and situational analysis, as well as developing a package of implementation strategies through an iterative process of concurrent implementation, evaluation, and model refinement based on programme learnings. The intervention package will include refresher training of ASHA/ANM workers, strengthened community awareness, and monthly Pradhan Mantri Surakshit Matritva Abhiyan specialist camps.

The study is expected to improve the identification and management of high-risk pregnancies and enhance the quality of institutional deliveries by strengthening the continuum of care across all stages of pregnancy. Thus, the study is expected to improve maternal and child health outcomes by developing sustainable strategies for scaling up evidence-based, context-specific interventions.

The study will generate a scalable implementation model that can be adopted more widely to streamline high-risk pregnancy care and contribute to long-term improvements in maternal and child health outcomes.