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

Yakoob, Mohammad Yawar, Ali, Mahrukh Ayesha, Ali, Mohammad Usman, Imdad, Aamer, Lawn, Joy E., Van Den Broek, Nynke ORCID: and Bhutta, Zulfiqar A. (2011) 'The effect of providing skilled birth attendance and emergency obstetric care in preventing stillbirths'. BMC Public Health, Vol 11, Issue Supp 3, :S7.

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Background: Of 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.

Methods: A 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%).
Results: The literature search yielded 871 hits. A total of 21 studies were selected for data abstraction. Our metaanalysis 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.

Conclusions: Both 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.

Item Type: Article
Additional Information: The electronic version of this article is the complete one and can be found online at:
Subjects: WA Public Health > Health Problems of Special Population Groups > WA 310 Maternal welfare
WQ Obstetrics > WQ 100 General works
WQ Obstetrics > Childbirth. Prenatal Care > WQ 155 Home childbirth
WQ Obstetrics > Pregnancy Complications > WQ 225 Spontaneous abortion. Fetal death
WQ Obstetrics > Labor > WQ 330 Complications of labor
Digital Object Identifer (DOI):
Depositing User: Users 19 not found.
Date Deposited: 28 Oct 2011 09:21
Last Modified: 25 Jan 2022 09:40


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