The effect of providing skilled birth attendance and emergency obstetric care in preventing stillbirths

BMC Public Health

Review

Zulfiqar A Bhutta¹  Mahrukh Ayesha Ali¹  Mohammad Usman Ali¹  Aamer Imdad¹  Mohammad Yawar Yakoob¹  Nynke Van Den Broek²  Joy E Lawn³ 

[1] Division of Women and Child Health, The Aga Khan University, P.O. Box 3500, Stadium Road, 74800, Karachi, Pakistan;Liverpool School of Tropical Medicine, Liverpool, UK;Saving Newborn Lives/Save the Children-US, Cape Town, South Africa;

关键词: Perinatal Mortality;    Stillbirth Rate;    Institutional Delivery;    Cesarean Section Rate;    Skilled Birth Attendant;   

DOI  :  10.1186/1471-2458-11-S3-S7

来源: Springer

【 摘 要 】

BackgroundOf the global burden of 2.6 million stillbirths, around 1.2 million occur during labour i.e. are intrapartum deaths. In low-/middle-income countries, a significant proportion of women give birth at home, usually in the absence of a skilled birth attendant. This review discusses the impact of skilled birth attendance (SBA) and the provision of Emergency Obstetric Care (EOC) on stillbirths and perinatal mortality.MethodsA systematic literature search was performed on PubMed/MEDLINE, Cochrane Database and the WHO regional libraries. Data of all eligible studies were extracted into a standardized Excel sheet containing variables such as participants’ characteristics, sample size, location, setting, blinding, allocation concealment, intervention and control details and limitations. We undertook a meta-analysis of the impact of SBA on stillbirths. Given the paucity of data from randomized trials or robust quasi-experimental designs, we undertook an expert Delphi consultation to determine impact estimates of provision of Basic and Comprehensive EOC on reducing stillbirths if there would be universal coverage (99%).ResultsThe literature search yielded 871 hits. A total of 21 studies were selected for data abstraction. Our meta-analysis on community-based skilled birth attendance based on two before-after studies showed a 23% significant reduction in stillbirths (RR = 0.77; 95% CI: 0.69 – 0.85). The overall quality grade of available evidence for this intervention on stillbirths was ‘moderate’. The Delphi process supported the estimated reduction in stillbirths by skilled attendance and experts further suggested that the provision of Basic EOC had the potential to avert intrapartum stillbirths by 45% and with provision of Comprehensive EOC this could be reduced by 75%. These estimates are conservative, consistent with historical trends in maternal and perinatal mortality from both developed and developing countries, and are recommended for inclusion in the Lives Saved Tool (LiST) model.ConclusionsBoth Skilled Birth Attendance and Emergency/or Essential Obstetric Care have the potential to reduce the number of stillbirths seen globally. Further evidence is needed to be able to calculate an effect size.

【 授权许可】

Unknown   
© Yakoob et al; licensee BioMed Central Ltd. 2011. This article is published under license to BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.