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Skilled Birth Attendance and Emergency Obstetric Care in Preventing Stillbirths

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More Intervention Effect Estimate Summaries

Yakoob MY, Ali MA, Ali MU, Imdad A, Lawn JE, Van Den Broek N, Bhutta ZA. The effect of providing skilled birth attendance and emergency obstetric care in preventing stillbirths. BMC Public Health. 2011; 11 (Suppl 3): S7.

• Of the 2.6 million stillbirths per year, roughly 1.2 million occur during labour i.e. intrapartum deaths. (1)
• These are primarily caused by complications arising during labour and childbirth, such as prolonged or obstructed labour or umbilical cord accidents (2, 3)
• Globally, 34% of deliveries (45 million births) take place without a skilled birth attendant. (4)

Intervention Effects

Skilled Birth Attendants (SBA) on Stillbirths

  • An SBA is defined as “an accredited health profession – such as a midwife, doctor or nurse – who has been educated and trained to proficiency in the skills needed to manage normal (uncomplicated) pregnancies, childbirth and the immediate postnatal period, and in the identification, management and referral of complications in women and newborns. (4)
  • 23% reduction in stillbirths (RR: 0.77; 95% CI 0.69-0.85) - meta-analysis of two before-after studies (moderate quality of evidence)
  • Delphi consensus process with 27 experts supported this estimation (25% reduction, IQR 20-42.5%)

Basic Emergency Obstetric Care (BEOC) on Stillbirths

  • BEOC comprises 7 “signal functions: use of intravenous/intramuscular antibiotics, intravenous/intramuscular oxytocin, and intravenous/intramuscular anticonvulsants, manual remove of retained placenta and removal of retained products of conception, assisted vaginal delivery and basic newborn resuscitation. (5)
  • The review found only low-quality historical and ecologic studies.
  • 45% reduction in intrapartum stillbirths with universal coverage of BEOC – suggested by 27 expert Delphi consensus process (IQR 30-40%)

Comprehensive Obstetric Care (CEOC) on Stillbirths

  • CEOC includes all BEOC signal functions plus Cesarean section and blood transfusion. (5)
  • The review found only low-quality historical and ecologic studies.
  • 75% reduction in intrapartum stillbirths with universal coverage of CEOC – suggested by 27 expert Delphi consensus process (IQR 30-40%)

Intervention Recommendation

  • This review recommends using the following estimates for inclusion in LiST: 23% reduction in intrapartum stillbirths with SBA, 45% reduction in intrapartum stillbirths with BEOC, and 75% reduction in intrapartum stillbirths with CEOC.
  • Further evidence is needed to be able to calculate the effect size.

References from Yakoob Paper Cited Here

  1. Bhutta ZA, Yakoob MY, Lawn JE, Rizvi A, Friberg IK, Weissman E, Buchmann E, Goldenberg RL; Lancet’s Stillbirths Series steering committee. Stillbirths: what difference can we make and at what cost? Lancet 2011 Apr 30; 377(9776):1523-38. 
  2. Lawn J, Shibuya K, Stein C. No cry at birth: global estimates of intrapartum stillbirths and intrapartum-related neonatal deaths. Bull World Health Organ. 2005;83(6):409–417.
  3. World Health Organization. Neonatal and perinatal mortality. Country, regional and global estimates. Geneva, Switzerland: World Health Organization; 2006. 
  4. Skilled Birth Attendants.
  5. Monitoring emergency obstetric care: a handbook: 2009.

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