uterus who are not woman identified, including trans men and non-binary individuals) and their unborn or newborn children (hereafter, children). Every year there are an estimated 139 million births worldwide [1]. An estimated 303,000 women die during pregnancy, birth or soon after [2], 2.6 million babies are stillborn [3] and 2.5 million infants die in the first month of life [4]. Maternal and perinatal morbidity and mortality are partly preventable. In the USA, for example, an estimated 63% of pregnancy-related maternal deaths [5] and 27%-54% of infant deaths among children born full-term are avoidable [6]. The Lancet series addressing maternal and newborn health [7–12] emphasized that preventable morbidity and mortality is associated with both underuse and overuse of care. A meta-synthesis in the Lancet series on Midwifery [12] pointed out that childbearing women and their children need a care system that helps them to stay healthy, and that provides a timely transition to medical specialist care for those who develop complications. Pregnancy and birth are primarily physiological processes but risks and complications can occur. The degree and type of risk related to pregnancy and birth differs between women and children, and between countries and care settings. To ensure women and children receive appropriate care, at the right place and the right time, an effective system of risk selection that differentiates between what care should be provided and who should provide it is a global necessity [13,14]. Kennedy and colleagues [15,16] identified the evaluation and comparison of models of risk selection across various settings as one of the top research priorities necessary to improve care. However, a key problem impeding cross-setting evaluation and comparison rests on the poor conceptualization of risk selection. The lack of conceptual clarity hinders the development of an evidence base for the most effective strategies to organise and practice risk selection. This is illustrated by the variety of ways in which risk selection is operationalized in research. For example, some scholars see risk selection as a skill in terms of health care professionals’ cognitive process [17–19]. Others understand risk selection as a means of organizing care [20–22]. Sometimes, risk selection is defined as a tool, for example in the application of risk indicators [23,24], the use of guidelines and protocols [25,26], and screening instruments [27–29]. Often, risk selection is seen as a safety system, meant to minimize morbidity and mortality mainly due to undertreatment [30–32]. A comprehensive understanding of risk selection, encompassing the relationship between these operationalisations remains absent, indicating a lack of shared conceptualisation of what risk selection entails in MNC. To enhance the understanding of risk selection in MNC we conducted a scoping review. We systematically searched the scientific literature, and examined papers spanning the last four decades to identify key dimensions of risk selection, using the following research question: how is the selection of childbearing women and children that require specialized care because of increased medical risks or actual complications conceptualized? Methods We conducted a scoping review, using a systematic design for the search and data selection, and inductive thematic analysis for the data analysis and data synthesis. We used a scoping review methodology based on the framework outlined by Arksy & O’Malley [33]. To enhance the framework, we took into consideration the following recommendations by Levac and colleagues [34] and Daudt and colleagues [35]: (1) we conducted considerable research about review studies to ensure an appropriate match between our research interest and the methodology, (2) we articulated a clear research question, rationale and purpose of the scoping review, which led the decision making throughout the study, (3) we assembled a research team with content and methodological expertise, consisting of an information specialist and researchers ONE Risk selection in maternal and newborn care | https://doi.org/10.1371/journal.pone.0234252 June 8, 2020 2 / 22 The author(s) received no specific this work. interests: The authors have declared interests exist. 70 3 CHAPTER 3
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