Ninety-four percent of global maternal deaths occur in low- and middle-income countries (LMICs). The UN has a goal of reducing maternal deaths to <70 per 100,000 live births by 2030, but progress is minimal. Maternal deaths in LMICs are associated with 3 delays in the care of women with obstetrical emergencies: 1) in the family of the woman realizing that her life is at risk, 2) in the transport of the woman to a hospital, and 3) in providing care after arrival at the hospital. These 3 delays function like links in a chain, and failure of any link leads to maternal death. LMICs have characteristics that make it likely that the chain will break. Women in LMICs frequently have low standing, and cultural beliefs often lead to delay in the recognition of obstetrical emergencies. LMICs are characterized by poor roads and long distances to hospitals leading to transport delays. Cultural and other factors also lead to treatment delays when a woman reaches a suitably-equipped and staffed hospital. Nepal has addressed these delays and reduced maternal mortality. Firstly, we have reported in the Journal the use of culturally acceptable approaches to improving the knowledge about antenatal care in remote villages. In the case of Nepal, singing songs related to maternal care proved to be a highly effective strategy. We now report that the government of Nepal has repurposed military helicopters to overcome the tyranny of poor roads to allow rapid transport of women with obstetrical emergencies to a small number of fully-equipped and staffed hospitals. As of June 2023, this service has successfully retrieved 625 women in four and half years. The Nepalese government has included questions on maternal mortality in the 2021 national census, followed by a verbal autopsy. These data indicate a fall in the maternal mortality ratio from 239 in 2016 to 151 in 2021. The efficiency of the triage service continues to improve, suggesting that maternal mortality will continue to fall. This may provide a model that can be implemented in other LMICs and highlights factors that may be responsible for recent increases in the US maternal mortality ratio.

中文翻译：

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降低低收入和中等收入国家的孕产妇死亡率：尼泊尔的直升机救援方法

全球 94% 的孕产妇死亡发生在低收入和中等收入国家 (LMIC)。联合国的目标是到 2030 年将孕产妇死亡率降低到每 10 万活产儿 70 例以下，但进展甚微。中低收入国家的孕产妇死亡与产科急症妇女的 3 种延误有关：1) 妇女的家人意识到她的生命处于危险之中，2) 将妇女送往医院，以及 3)到达医院后提供护理。这三个延迟就像链条中的一环，任何一环的故障都会导致孕产妇死亡。中低收入国家的特点很可能导致链条断裂。中低收入国家的妇女地位往往较低，文化信仰往往导致对产科急症的认识延迟。中低收入国家的特点是道路状况较差，距医院距离较远，导致交通延误。当女性到达设备齐全、人员配备合适的医院时，文化和其他因素也会导致治疗延误。尼泊尔已经解决了这些延误问题并降低了孕产妇死亡率。首先，我们在《杂志》中报道了使用文化上可接受的方法来提高偏远村庄的产前保健知识。就尼泊尔而言，唱与孕产妇护理相关的歌曲被证明是一种非常有效的策略。我们现在报告说，尼泊尔政府重新调整了军用直升机的用途，以克服道路条件恶劣的问题，以便将患有产科紧急情况的妇女快速运送到少数设备齐全、人员配备齐全的医院。截至2023年6月，该服务在四年半的时间里已成功寻回625名女性。尼泊尔政府在 2021 年全国人口普查中纳入了孕产妇死亡率问题，随后进行了口头尸检。这些数据表明，孕产妇死亡率从2016年的239人下降到2021年的151人。分诊服务的效率不断提高，表明孕产妇死亡率将继续下降。这可能提供一个可以在其他中低收入国家实施的模型，并强调可能导致美国孕产妇死亡率近期上升的因素。