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Reducing stillbirths: interventions during labour.

Gary L Darmstadt1, Mohammad Yawar Yakoob, Rachel A Haws

  • 1Department of International Health, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA. gdarmsta@jhsph.edu

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|May 12, 2009
PubMed
Summary
This summary is machine-generated.

Intrapartum stillbirths are largely preventable with quality obstetric care. Operative delivery, like Caesarean sections, and induction of labor for post-term pregnancies show promise in reducing stillbirths, especially in low-resource settings.

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Area of Science:

  • Obstetrics and Gynecology
  • Perinatal Health
  • Public Health

Background:

  • Approximately one million annual stillbirths occur during labor, predominantly in low and middle-income countries due to inadequate obstetric care.
  • High-income countries demonstrate that intrapartum stillbirths are preventable with quality intrapartum care and timely management of complications.
  • Systematic examination of evidence for intrapartum interventions' impact on stillbirth and perinatal mortality is lacking.

Purpose of the Study:

  • To systematically review the evidence on the impact of intrapartum interventions on stillbirth and perinatal mortality outcomes.
  • To identify effective interventions for reducing intrapartum stillbirths, particularly in resource-limited settings.

Main Methods:

  • A systematic review of 230 trials and reviews from PubMed and the Cochrane Library was conducted.
  • Meta-analysis was performed, incorporating new trial findings into existing Cochrane reviews where applicable.
  • Studies reporting stillbirth or perinatal mortality outcomes for eight labor interventions were included.

Main Results:

  • Limited statistically significant evidence exists for interventions impacting perinatal mortality, especially stillbirths.
  • Operative delivery, particularly Caesarean section, is associated with decreased stillbirth rates.
  • Induction of labor for post-term pregnancies shows strong evidence of impact; planned Caesarean section for term breech presentation reduces stillbirths but has implementation caveats for low-resource settings.

Conclusions:

  • Emergency obstetric care, including Caesarean section, is life-saving and crucial for reducing stillbirth rates, especially in low-resource settings.
  • While interventions like amnioinfusion and hyperoxygenation show potential, further research on safety and effectiveness is needed before routine implementation.
  • Safe, comprehensive obstetric care is essential for significantly impacting global stillbirth rates.