PURPOSE:
This abstract shares implementation insights from delivering a collaborative, midwife-to-midwife training program focused on pregnancy associated acute kidney injury (PrAKI) and fluid balance at University of Zambia and Ndola Teaching Hospital in Zambia. The aim was to enhance midwives' knowledge, skills, and confidence in identifying and managing PrAKI, fostering sustainable professional development thereby improving maternal outcomes

DISCUSSION:
PrAKI affects up to 22.2% of pregnant women in some regions, with obstetric haemorrhage, eclampsia, and sepsis among the leading causes. Many cases are preventable if detected and managed early. Recognising the knowledge-practice gap, we implemented early stakeholder engagement to co-design training content and implementation model with maternity educators, clinical governance leads, and nephrology and obstetric specialists, to ensure local relevance and alignment with development goals. Pre-training activities included stakeholder mapping, locally adapted materials and baseline assessments to identify implementation barriers. Training was co-facilitated by local and visiting midwives, using real-life scenarios and interactive exercises on fluid balance and early PrAKI recognition. Peer-led learning encouraged confidence-building and reflection. Structured pre-training activities included simplified reading materials and baseline knowledge surveys. Post-training follow-up included mentorship, peer-review sessions, and reflective journaling to reinforce learning. The program adopted mentorship and collaborative learning strategies, promoting mutual respect and fostering continuous professional growth. Time constraints and varying baseline knowledge were managed through flexible scheduling and tailored group discussions.

EVIDENCE WHERE RELEVANT:
Implementation outcomes included high reach (95% attendance), acceptability and adoption (increased use of fluid balance monitoring). Peer-to-peer learning significantly contributed to shared problem-solving and improved care practices.

KEY MESSAGE:
Embedding structured implementation strategies, including co-design, peer-learning, mentorship and iterative follow-up, within midwife-led, peer-to-peer training onPrAKI led to high engagement, strengthened professional agency and early signs of practice change. This model aligns with targets within the WHO and ICM Midwifery Accelerator to strengthen midwifery leadership and maternal health outcomes. Poster session 3 (Group B)