Abstract
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.
Highlights
Of the global burden of 2.6 million stillbirths, around 1.2 million occur during labour i.e. are intrapartum deaths
We review available evidence to ascertain the effect of provision of skilled birth attendance as well as basic and emergency obstetric care on stillbirths
Searches A systematic literature search was performed on PubMed/MEDLINE, Cochrane Database and the WHO regional libraries
Summary
Of the global burden of 2.6 million stillbirths, around 1.2 million occur during labour i.e. are intrapartum deaths. Of the estimated global burden of 2.6 million stillbirths per year, around 1.2 million occur during labour i.e. are 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]. To ensure optimal pregnancy outcomes, all women and babies need access to appropriate maternity care in pregnancy, childbirth and after delivery. This includes skilled birth attendance, and provision of basic and emergency obstetric care, for women with complications in pregnancy, childbirth or postpartum. The definition of a skilled attendant is “an accredited health professional – 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]
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