The study group identified many gaps in the evidence required to achieve the Millenium Development Goals 4 and 5. The three most important pieces of research in each area that would address these deficiencies are described below.

Assessing the problem

Audit of maternal deaths

1. All countries should actively enumerate and audit maternal and perinatal deaths.

Disease issues

Postpartum haemorrhage

Prophylaxis

2. Research is needed into the most appropriate components of the active management of the third stage of labour, including the role of controlled cord traction, the role of universal prophylaxis with oxytocics and the most appropriate prophylactic drug in each healthcare setting.

Management of retained placenta

3. Research is needed into the optimal management of retained placenta, including timing of therapeutic interventions.

Treatment of postpartum haemorrhage

4. Research is needed into the most clinically and cost-effective combination of medical and surgical therapy for the management of postpartum haemorrhage, including the role of the non-pneumatic shock garment.

Puerperal sepsis

Disease burden

5. Research is needed to quantify the disease burden related to puerperal sepsis.

Interventions

6. The effectiveness of interventions, particularly those that comprise multiple components related to influencing behaviour and creating improvements in the health system, should be rigorously tested. Research should ideally be conducted in settings where the risk of introducing infection is high.

Cost effectiveness

7. Evaluation of interventions should include analysis of cost effectiveness.