Highlight
– National scale-up of the CRADLE Vital Signs Alert (a combined pulse, blood pressure and shock index device with a traffic‑light alert system) in Sierra Leone was feasible and associated with increased frequency and accuracy of vital‑sign measurement in maternity services.
– Despite improved detection and referrals, there was no measurable reduction in a composite clinical outcome (eclampsia, emergency hysterectomy, maternal death, or stillbirth) across 93,811 deliveries (IRR 1.01, 95% CI 0.87–1.16).
