Abstract：
Emergency obstetric care (EmOC) signal functions are a shortlist of key clinical interventions capable of averting deaths from the five main direct causes of maternal mortality; they have been used since 1997 as a part of an EmOC monitoring framework to track the availability of EmOC services in low- and middle-income settings. Their widespread use and proposed adaptation to include other types of care, such as care for newborns, is testimony to their legacy as part of the measurement architecture within reproductive health. Yet, much has changed in the landscape of maternal and newborn health (MNH) since the initial introduction of EmOC signal functions. As part of a project to revise the EmOC monitoring framework, we carried out a meta-narrative inspired review to reflect on how signal functions have been developed and conceptualised over the past two decades, and how different narratives, which have emerged alongside the evolving MNH landscape, have played a role in the conceptualisation of the signal function measurement. We identified three overarching narrative traditions: 1) clinical 2) health systems and 3) human rights, that dominated the discourse and critique around the use of signal functions. Through an iterative synthesis process including 19 final articles selected for the review, we explored patterns of conciliation and areas of contradiction between the three narrative traditions. We summarised five meta-themes around the use of signal functions: i) framing the boundaries; ii) moving beyond clinical capability; iii) capturing the woods versus the trees; iv) grouping signal functions and v) measurement challenges. We intend for this review to contribute to a better understanding of the discourses around signal functions, and to provide insight for the future roles of this monitoring approach for emergency obstetric and newborn care.
摘要：
紧急产科护理（EmOC）信号功能是能够避免因孕产妇死亡的五个主要直接原因而死亡的关键临床干预措施的候选清单；自1997年以来，它们已被用作EmOC监测框架的一部分，以跟踪低收入和中等收入环境中EmOC服务的可用性。它们的广泛使用和拟议的适应包括其他类型的护理，比如照顾新生儿，证明了他们作为生殖健康测量架构一部分的遗产。然而，自从最初引入EmOC信号功能以来，孕产妇和新生儿健康（MNH）的格局发生了很大变化。作为修改EmOC监测框架项目的一部分，我们进行了元叙事启发的审查，以反映信号功能是如何发展和概念化在过去的二十年，以及不同的叙述，随着不断发展的MNH景观出现，在信号函数测量的概念化中发挥了作用。我们确定了三个总体叙事传统：1）临床2）卫生系统和3）人权，主导了围绕信号功能使用的话语和批评。通过迭代综合过程，包括19篇最终文章，我们探索了三种叙事传统之间的和解模式和矛盾领域。我们总结了围绕信号功能使用的五个元主题：i）确定边界；ii）超越临床能力；iii）捕获树林和树木；iv）分组信号功能和v）测量挑战。我们打算让这次审查有助于更好地理解围绕信号功能的论述，并为这种监测方法在急诊产科和新生儿护理中的未来作用提供见解。
