Levels and Trends of Maternal Mortality and Morbidity by Cause in North Africa and Middle East, 1990 to 2019: An Analysis for the Global Burden of Disease Study 2019

Background: Since 1990, the maternal mortality significantly decreased at global scale as well as the North Africa and Middle East. However, estimates for mortality and morbidity by cause and age at national scale in this region are not available. Method(s): This study is part of the Global Burden of Diseases, Injuries, and Risk Factors study (GBD) 2019. Here we report maternal mortality and morbidity by age and cause across 21 countries in the region from 1990 to 2019. Result(s): Between 1990 and 2019, maternal mortality ratio (MMR) dropped from 148.8 (129.6-171.2) to 94.3 (73.4-121.1) per 100 000 live births in North Africa and Middle East. In 1990, MMR ranged from 6.0 (5.3-6.8) in Kuwait to 502.9 (375.2-655.3) per 100 000 live births in Afghanistan. Respective figures for 2019 were 5.1 (4.0-6.4) in Kuwait to 269.9 (195.8-368.6) in Afghanistan. Percentages of deaths under 25 years was 26.0% in 1990 and 23.8% in 2019. Maternal hemorrhage, indirect maternal deaths, and other maternal disorders rank 1st to 3rd in the entire region. Ultimately, there was an evident decrease in MMR along with increase in socio-demographic index from 1990 to 2019 in all countries in the region and an evident convergence across nations. Conclusion(s): MMR has significantly declined in the region since 1990 and only five countries (Afghanistan, Sudan, Yemen, Morocco, and Algeria) out of 21 nations didn't achieve the Sustainable Development Goal (SDG) target of 70 deaths per 100 000 live births in 2019. Despite the convergence in trends, there are still disparities across countries.Copyright © 2022 Academy of Medical Sciences of I.R. Iran. All rights reserved.

What are the mental health issues of postpartum mothers during a pandemic? A scoping review

Background. Postpartum mothers' mental health has a significant role in mothers' well-being and child's growth and develop-ment. This issue is worsened during a pandemic when social restrictions are regulated, resulting in perceived stress, baby blues, postpartum depression, and other mental health issues. Objective. This study intends to investigate postpartum moth-ers' mental health during the COVID-19 pandemic. Methods. This study's methodology is a scoping review using the prism-ScR checklist, the Joanna Briggs Institute critical appraisal tool, and a population, exposure, outcome framework. It uses 4 databases: Pubmed, Willey, Proquest, and ScienceDirect;its inclusion criteria is original English articles that can be accessed in full text between 2020 and 2022. Results. Out of 190 publications, we found 7 that are pertinent to the research goals. Qualitative research, cross-sectional studies, and longitudinal studies make up the research. The mapping result includes 4 themes: the types of mental health problems experi-enced by postpartum moms during the Pandemic, risk and predic-tive factors, postpartum mothers' experiences, and the effects of mothers' mental health problems. Conclusion. After giving birth, most mothers experience stress, anxiety, and depression. Postpartum mental health concerns are influenced by isolation, social exclusion, and crises. The cre-ation of a customized plan for early assistance for a woman's mental health requirements, as well as the establishment of an accessi-ble mental health provider, including medical personnel and medical facilities, is advised for pregnant and postpartum women. only.Copyright © the Author(s), 2023.

The post-discharge coping difficulty of puerperal women in a middle and low-income tourist city during the COVID-19 pandemic.

BACKGROUND: Since the coronavirus disease 2019 (COVID-19) pandemic outbreak, the incidence of mental health problems in perinatal women has been high, and particularly prominent in China which was the first country affected by COVID-19. This paper aims to investigate the current situation and the related factors of maternal coping difficulties after discharge during COVID-19. METHODS: General information questionnaires (the Perinatal Maternal Health Literacy Scale, Postpartum Social Support Scale and Post-Discharge Coping Difficulty Scale-New Mother Form) were used to investigate 226 puerperal women in the third week of puerperium. The influencing factors were analyzed by single factor analysis, correlation and multiple linear regression. RESULTS: The total score of coping difficulties after discharge was 48.92 ± 12.05. At the third week after delivery, the scores of health literacy and social support were 21.34 ± 5.18 and 47.96 ± 12.71. There were negative correlations among health literacy, social support and coping difficulties after discharge (r = -0.34, r = -0.38, P < 0.001). Primipara, family income, health literacy and social support were the main factors influencing maternal coping difficulties after discharge. CONCLUSION: During the COVID-19 pandemic, puerperal women in a low- and middle-income city had moderate coping difficulties after discharge and were affected by many factors. To meet the different needs of parturients and improve their psychological coping ability, medical staff should perform adequate assessment of social resources relevant to parturients and their families when they are discharged, so they can smoothly adapt to the role of mothers.

Trends of Maternal Deaths in a Tertiary Care Hospital of Southern India in the Pre-COVID-19 Era: A 10-Year Retrospective Study

Background: The current United Nations sustainable development goal 3 sets to reduce maternal mortality to less than 70 per 100 000 live births by 2030. To monitor whether India is on track to attaining sustainable development goals, it is essential to routinely assess trends of health indicators. Objective(s): This study was conducted to assess trends of maternal mortality and cause-specific maternal death in tertiary care hospitals in Southern India. Method(s): This is a retrospective study of hospital records and death summaries of all maternal deaths between January 1, 2009, and December 31, 2018, at the tertiary care hospital in Southern India. The demographic, clinical, and delivery details of all the maternal deaths were collected. Causes of maternal deaths were classified as direct, indirect, and nonspecific. To observe trends of maternal death, the maternal mortality ratio was calculated for each year, and Pearson's chi-square test was used. Result(s): Maternal mortality ratio was 555/100000 and had a decreasing trend from its highest in 2010 of 1230/100000 to its lowest of 229/100000 in 2017 (t = 7.71 p = 0.02). The majority of women who died were aged 21-35 years, resided in rural, were primigravidae, and had operative delivery. Most of the maternal deaths had been referred to our facility (90.8%) from other healthcare units. Obstetric hemorrhage (27.8%) and puerperal sepsis (37.7%) among direct causes;H1N1 pneumonia (34.8%) among indirect causes were the major causes of maternal death. The number of maternal deaths due to sepsis increased from the beginning until the end of the study from 10% to 50% (t = 5.9, p = 0.01). On the contrary, there was a decline in maternal deaths due to obstetric hemorrhage from 50% to 25% (t = 4.2, p = 0.03). Conclusion(s): Although the maternal mortality ratio has reduced over the years, sepsis was an important cause of maternal deaths.Copyright © 2023 Bentham Science Publishers.

Semmelweis: his fight for hand hygiene

Clinicians today have never, perhaps, been more aware of the utmost importance of handwashing prior to clinical examination and surgery. However, in the 1800s this was not the case. The simple act of handwashing was once ridiculed and debated with considerable controversy within the medical profession. It was obstetrician Ignaz Semmelweis (1818-1865) who put forward its importance, and thereafter Joseph Lister who, in 1864, developed antiseptic techniques in surgery, following on from Pasteur and Koch's work on germ theory. In 1846, Dr Semmelweis was working in Vienna, responsible for the first division of maternity services. He noticed the striking difference in mortality rate in women who had deliveries by doctors and medical students, compared with deliveries by midwives. This mortality was known as puerperal fever or childbed fever. He hypothesized that doctors and medical students were transferring 'cadaverous particles' as they handled cadavers during autopsies, and then went on to examine pregnant women. The mortality rate was lower when midwives, who did not handle cadavers, performed deliveries. Thereafter, he initiated mandatory handwashing for all those delivering babies, using chloride of lime solution. The mortality rate reduced significantly after the implementation of handwashing and the washing of medical instruments. However, Semmelweis's hypothesis was not supported by many in the medical profession, and most senior academics questioned and disregarded his conclusions. He subsequently returned to Budapest where he continued to work and undertake handwashing. He published 'The etiology, concept, and prophylaxis of childbed fever' in 1861, but it was deemed a laborious read and was poorly received. Unfortunately, reports indicate that Semmelweis's behaviour and actions deteriorated, some speculated due to early-onset dementia or syphilis. He was admitted to a Viennese psychiatric hospital and died in 1865 aged 47 years. Ironically, given his passion for hygiene, he died from sepsis due to a wound infection. Semmelweis has been acknowledged with a university hospital and museum named after him, as well as a postage stamp, issued in Austria in 1965 on the 100th anniversary of his death. Many lessons have been learned from Semmelweis. The medical establishment was slow to adopt his advice. Handwashing effectively reduces healthcare-associated infections, and clinician adherence to hand hygiene advice has increased since the advent of the COVID-19 pandemic. The World Health Organization's 'My 5 moments for hand hygiene' is known worldwide, with its most recent caption (2021) 'Seconds save lives - clean your hands'.

Newborns Born to Sars-Cov-2-Positive Mothers: A Single Institutional Experience

Introduction. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) caused the "coronavirus disease 2019" (COVID-19) pandemic, which started in late 2019 and has spread rapidly all over the world. Today it is the main global medical problem affecting the population of all ages. Data on the general condition and potential complications of neonates born to mothers with SARS-CoV-2 infection have been reported all around the world. Herein we present our observations derived from almost three months of work with infants born to SARS-CoV-2-infected mothers. Material and methods. Forty-two neonates born to women with positive SARS-CoV-2 antigen tests between December 2020 and February 2021 in the infective obstetric unit at Wroclaw's Regional Hospital were analyzed with respect to epidemiologic and clinical data obtained from the personal observations and medical records system. Results. Nineteen of the neonates were male (45%) and the median birth term was 39 weeks of gestation. All of the newborns had negative Antigen Rapid Test result for SARS-CoV-2 after birth. Most of them were asymptomatic, except 6 who presented with pneumonia. One of the symptomatic children had positive SARS-CoV-2 antigen and real-time reverse transcriptase-polymerase chain reaction (PCR) tests on the 9th day of life. It is likely that he acquired postpartum infection from his mother. None required invasive ventilation and no deaths were reported. Conclusions. Our study presented that post-birth, most babies of SARS-CoV-2-positive mothers are not infected by the virus and confirmed the fact that the risk of perinatal moth-er-to-child transmission is rather low.Copyright © 2022, Wydawnictwo Czelej Sp. z o.o.. All rights reserved.

COVID-19: Impact of Original, Gamma, Delta, and Omicron Variants of SARS-CoV-2 in Vaccinated and Unvaccinated Pregnant and Postpartum Women.

This study compares the clinical characteristics and disease progression among vaccinated and unvaccinated pregnant and postpartum women who tested positive for different variants of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) using the Brazilian epidemiological data. Data of pregnant or postpartum patients testing positive for SARS-CoV-2 and presenting with coronavirus disease 2019 (COVID-19) from February 2020 to July 2022 were extracted from Brazilian national database. The patients were grouped based on vaccination status and viral variant (original, Gamma, Delta, and Omicron variants), and their demographics, clinical characteristics, comorbidities, symptoms, and outcomes were compared retrospectively. Data of 10,003 pregnant and 2361 postpartum women were extracted from the database. For unvaccinated postpartum women, intensive care unit (ICU) admission was more likely; invasive ventilation need was more probable if they tested positive for the original, Gamma, and Omicron variants; and chances of death were higher when infected with the original and Gamma variants than when infected with other variants. Vaccinated patients had reduced adverse outcome probability, including ICU admission, invasive ventilation requirement, and death. Postpartum women showed worse outcomes, particularly when unvaccinated, than pregnant women. Hence, vaccination of pregnant and postpartum women should be given top priority.

Puerperal depression risk assessment in new mothers hospitalized during COVID-19 lockdown measures

Objective. International studies have found an increased risk of puerperal depression during COVID-19 pandemic. The present research aims to investigate the risk of puerperal depression within the obstetrics ward of Ospedale dell’Angelo (Venice Mestre), between March and June, 2020. Patients and Methods. 98 new mothers (average age: 33 y/o, SD: 5) were asked to complete the 10 item version of the EPDS, 2-3 days after delivery and again 3 months later. Results. The percentage of women with high score is 26.5%, less than what was found in 2016. The risk of puerperal depression does not change significantly 3 months after delivery. However, high scores on EPDS do not seem to be connected either to the type of birth or to the condition of primiparity of the mothers. Conclusions. Some hypotheses have been proposed to explain the results obtained, such as quality of the assistance offered and/or the compliance and the coping skills acquired by families, which could be evaluated in future research. © 2022, EDRA S.p.A. All rights reserved.

MANAGEMENT OF AUTOIMMUNE HAEMOLYTIC ANAEMIA DURING PREGNANCY OR POST-PARTUM: AN INTERNATIONAL MULTI-CENTRE EXPERIENCE

Background: Autoimmune haemolytic anaemia (AIHA) during pregnancy is a rare finding, and few is known about maternal and foetal outcomes. AIHA may either develop or relapse during gestation and postpartum or be an issue in a patient on active therapy who becomes pregnant. AIHA management during pregnancy and lactation is not standardized and drug use is often limited by safety concerns. Aims: We studied AIHA impact on pregnancy focusing on disease severity, treatment need and maternal/foetal outcome. Methods: Through a multicentric retrospective cohort study, we identified 38 pregnancies occurred in 28 women from 1997 to 2021 in 10 European centres in Italy, Denmark, France, the Netherlands, USA, and Spain. All included patients had a previous AIHA history or developed/exacerbated AIHA during gestation or postpartum. AIHA was classified according to the direct antiglobulin test. Results: We registered 18 warm AIHA (10 IgG;8 IgG+C3d), 2 cold agglutinin disease, 3 mixed and 5 atypical forms (Table 1). Evans syndrome (i.e., association of AIHA and immune thrombocytopenia or neutropenia) was present in 4. Mean age at AIHA diagnosis was 27 (3-39) and at pregnancy 32 (21-41) years. AIHA diagnosis predated pregnancy in 15 women and had required at least 1 therapy line in all of them, and >2 lines in 12 (rituximab, N=7;cytotoxic immunosuppressants, N=6;splenectomy, N=5). Among these 15 patients, 6 had a relapse during pregnancy, 3 during postpartum and 9 were on active treatment at the time of pregnancy (steroids, N=8;cyclosporine, N=1;azathioprine, N=1;the latter stopped after positive pregnancy test). A patient with a previous AIHA, relapsed as immune thrombocytopenic purpura during pregnancy. Further 8 patients had an AIHA onset during gestation and 2 postpartum. A patient had AIHA onset during the postpartum of the 1st pregnancy and relapsed during the 2nd one. In the 20 women experiencing AIHA during pregnancy/postpartum, median Hb and LDH levels were 6,4 g/dL (3,1 - 8,7) and 588 UI/L (269-1631), respectively. Management consisted in blood transfusions (N=10) and prompt establishment of steroid therapy+/-IVIG (N=20), all with response (complete N=13, partial N=7). After delivery, rituximab was necessary in 4 patients and cyclosporine was added in one. Anti-thrombotic prophylaxis was given in 7 patients. Overall, we registered 10 obstetric complications (10/38, 26%), including 4 early miscarriages, a premature rupture of membranes, a placental detachment, 2 preeclampsia, a postpartum infection and a biliary colic. Apart from the case of biliary colic and one of the two cases of preeclampsia, 8/10 complications occurred during active haemolysis and treatment for AIHA. Nine foetal adverse events (9/38, 24%) were reported: a transitory respiratory distress of the new-born in a mother with active AIHA, 3 cases of foetal growth restriction, a preterm birth, an infant reporting neurologic sequelae, a case of AIHA of the new-born requiring intravenous immunoglobulins, blood transfusions and plasma exchange, and 2 perinatal deaths. The latter both occurred in women on active AIHA therapy and were secondary to a massive placental detachment and a symptomatic SARS-CoV-2 infection. (Figure Presented ) Summary/Conclusion: AIHA developing/reactivating during pregnancy or postpartum is rare (about 5%) but mainly severe requiring steroid therapy and transfusions. Importantly, severe maternal and foetal complications may occur in up to 26% of cases mostly associated with active disease, pinpointing the importance of maintaining a high level of awareness. Passive maternal autoantibodies transfer to the foetus seems a rare event.

Analysis of pathogenic bacteria, their drug resistance, and cytokines in 60 patients with a puerperal infection after a Cesarian section

Objectives: To investigate pathogenic bacteria, their drug resistance, and changes in levels of cytokines in patients with a puerperal infection after a Cesarean section.

Targeting metabolic health promotion to optimise maternal and offspring health

There is an increase in maternal metabolic burden due to the rise in pregnancies complicated by obesity, gestational diabetes, type 2 diabetes and polycystic ovary syndrome. Metabolic dysfunction during pregnancy is associated with increased risks of long-term morbidity and mortality for women and their offspring. Lifestyle interventions in pregnancy in women at risk of metabolic dysfunction have demonstrated short-term improvements such as reduced gestational weight gain and lowered risk of gestational diabetes. It is not known whether these interventions lead to sustained improvements in the metabolic health of the mother and baby. Pharmacological interventions have also shown benefits for the mother and baby in pregnancy, including improvements in glycaemic control, reduction in gestational weight gain and reduction in large for gestational age infants;however, there remains uncertainty over long-term outcomes for mother and child. Existing studies on interventions targeting metabolic health are limited to selected populations in the preconception and postpartum periods and lack follow-up beyond delivery of the intervention. The COVID-19 pandemic has refocused our attention on the effects of maternal metabolic ill-health that play a role in contributing to premature morbidity and mortality. There is an urgent need for strategies to accurately identify the growing number of women and offspring at risk of long-term adverse metabolic health. Strategies which focus on early identification and risk stratification using individualised risk scores in the pre and inter-conception periods must take priority if we are to target and improve the metabolic health of women and their offspring who are at highest risk. [ FROM AUTHOR] Copyright of European Journal of Endocrinology is the property of Bioscientifica and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Louis Pasteur: Between Myth and Reality.

Louis Pasteur is the most internationally known French scientist. He discovered molecular chirality, and he contributed to the understanding of the process of fermentation, helping brewers and winemakers to improve their beverages. He proposed a process, known as pasteurization, for the sterilization of wines. He established the germ theory of infectious diseases that allowed Joseph Lister to develop his antiseptic practice in surgery. He solved the problem of silkworm disease, although he had refuted the idea of Antoine Béchamp, who first considered it was a microbial infection. He created four vaccines (fowl cholera, anthrax, pig erysipelas, and rabies) in the paths of his precursors, Henri Toussaint (anthrax vaccine) and Pierre Victor Galtier (rabies vaccine). He generalized the word "vaccination" coined by Richard Dunning, Edward Jenner's friend. Robert Koch, his most famous opponent, pointed out the great ambiguity of Pasteur's approach to preparing his vaccines. Analysis of his laboratory notebooks has allowed historians to discern the differences between the legend built by his hagiographers and reality. In this review, we revisit his career, his undeniable achievements, and tell the truth about a hero who made every effort to build his own fame.

Comparison of sleep quality among puerperal women before and during the COVID-19 pandemic: a cross-sectional survey in Lanzhou, China.

PURPOSE: Few studies have yet examined sleep quality among puerperal women during the coronavirus disease 2019 (COVID-19) pandemic. This cross-sectional study aimed to compare the sleep quality of puerperal women before and during the COVID-19 pandemic in Lanzhou, China. The study exploreed the factors that affect sleep quality among puerperal women. METHODS: The study population comprised puerperal women who went to the obstetric department of the Gansu Provincial Maternity and Childcare Hospital on the 42nd day after childbirth. Sleep quality was measured using the Pittsburgh Sleep Quality Index (PSQI). Data were collected by doctors in the obstetric department before the COVID-19 pandemic (Oct.-Dec. 2019) and during the COVID-19 pandemic (Feb.-Apr. 2020) in China. Multiple linear regressions were used to examine the association between the sleep quality of puerperal women and COVID-19 and to identify factors that affect the total PSQI scores. RESULTS: In 2019, 546 puerperal women were assessed compared with 655 who were assessed in 2020. Compared with before COVID-19, the total PSQI scores of puerperal women improved during the COVID-19 pandemic. In addition, the influencing factors of sleep quality among puerperal women were the pandemic itself, age, conception method, and postpartum depression (PPD). CONCLUSIONS: In contrast with other studies, there was no evidence for worsening sleep quality of puerperal women during the COVID-19 pandemic in Lanzhou, China. Puerperal women who underwent assisted pregnancy or developed PPD were more likely to experience poor sleep quality.

[Internal medical emergencies in the pregnant patient : Peripartum sepsis, metabolic derailment, endocrinological emergencies and pulmonary edema]. / Internistische Notfälle bei der schwangeren Patientin : Peripartale Sepsis, Stoffwechselentgleisungen, endokrinologische Notfälle und Lungenödem.

Peripartum emergencies that require intensive medical care represent a major challenge for the interdisciplinary treatment team. Due to physiological changes in pregnant women symptoms can be masked and the initiation of treatment is delayed. Peripartum sepsis has a relatively high incidence. The anti-infective treatment depends on the spectrum of pathogens to be expected. Endocrinological emergencies are rare but can be fulminant and fatal. The development of ketoacidosis is favored by decreased bicarbonate buffer and placental hormones. In the case of thyrotoxicosis, propylthiouracil and thiamazole are available for treatment depending on the stage of gestation. Sheehan's syndrome is an infarction of the anterior lobe of the pituitary gland during a hemorrhage. Due to the loss of production of vital hormones, this can be fatal. The development of pulmonary edema is just as acute. This is favored by physiological changes during pregnancy. The differentiation between hypertensive and hypotensive pulmonary edema is important for the causal treatment.

GESTACOVID project: psychological and perinatal effects in Spanish pregnant women subjected to confinement due to the COVID-19 pandemic.

INTRODUCTION: COVID-19 was declared a pandemic and confinement with movement restriction measures were applied in Spain. Postnatal mental disorders are common but frequently undiagnosed, being a risk period to develop anxiety and depression symptoms. The aim of this study is to evaluate the impact of confinement as depressive and anxiety symptoms in pregnant women (PrW) and puerperal women (PuW) mental health, as well as obstetric and perinatal outcomes during this period. MATERIALS AND METHODS: The self-administered survey consists of a total of 28 questions, the first 16 providing contextual information and the following ones corresponding to the GHQ-12 that has been evaluated in a binomial form. A logistic regression model has been used to assess whether the contextual variables acted as a protective or risk factor and its fitting has been represented by a receiver operating curve. RESULTS: Of the 754 PrW interviewed, 58.22% were screened positive. Confinement time for these was 54.93 ± 9.75 days. The risk factors that were identified after the refinement have been to have a worse general state of health, to be sadder and to be more nervous. Among the protectors have been found to have a higher Apgar 10 score and induction of labor. The area under the adjusted regression adjustment curve was 0.8056. CONCLUSIONS: Our results show a high prevalence of depression and anxiety symptoms with strict confinement measures. PrW and PuW must be considered a risk group to develop mental health disorders during disruption circumstances. Using a mental health screening tool could help to identify a group of patients with more risk and to carry out a careful monitoring to allow adequate management.

Using Historical Scientific Controversies to Promote Undergraduates' Argumentation.

The Covid-19 pandemic is the reason why humanity is paying more attention to the importance of regular and rigorous handwashing. Interestingly, in the nineteenth century, regular and rigorous handwashing was a key (and controversial) solution proposed by the Hungarian obstetrician Ignaz Philipp Semmelweis to cut drastically cases of puerperal fever. The purpose of this study was to provide evidence that the case of Semmelweis and puerperal fever-a crucial historical scientific controversy-can be used as a springboard to promote university student argumentation. Our study was inspired by the fact that the Organization for Economic and Cooperative Development (OECD) stressed that more efforts and resources should be invested in promoting argumentation as an essential component for scientifically literate citizens in twenty-first century societies. However, nowadays, argument and debate are virtually absent from university science education. The data was derived from 124 undergraduates' (64 females and 60 males, 15-30 years old) written responses and audio and video recordings in a university biology course in Colombia. The findings show that the articulation of this historical controversy with decision-making, small-group debate, and whole-class debate activities can be useful for promoting undergraduates' argumentation. This study contributes to the development of a research-based university science education that can inform the design of an argumentation curriculum for higher education.

Ignac Semmelweis-Father of Hand Hygiene.

Hungarian obstetrician Ignac Semmelweis (1818-1865) was one of the earliest clinical investigators of modern medical science. In nineteenth century Europe, puerperal fever (childbed fever) was a major clinical and public health problem with very high maternal mortality. It was thought to be caused by miasma, epidemicity, or the Will of Providence. Apart from bloodletting, there was no cure for it. Semmelweis cared for the childbed fever women during their illness, and when they died, he did autopsies on them. Astute clinical observations and logical reasoning goaded Semmelweis to suspect the role of "unholy" hands of "holy" physicians in the transmission of puerperal fever. He enforced a hand-washing policy for physicians. Those with unwashed hands were disallowed into labor room. The hand-washing practice for 1 year led to unprecedented decrease in maternal mortality. It enabled Semmelweis to establish a strong, specific, temporal causal association between unclean hands and puerperal fever. Although not accepted during his lifetime, this causal hypothesis contributed significantly to the understanding of etiopathophysiology of not only puerperal fever but also many other communicable diseases. Clinical hand washing, since then, has prevented millions of deaths of humankind. In the present times too, his idea of hand hygiene plays a central role in COVID-19 pandemic management. Authors present a brief account of life and work of this maverick genius, who was born "too early in the darkness." He is also called the "Father of infection control" and "Savior of mothers."