Evidence map›Paper›PMID 21501458›Full record

SynthesisBMC public health2011

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

Mohammad Yawar Yakoob, Mahrukh Ayesha Ali, Mohammad Usman Ali, Aamer Imdad, Joy E Lawn, Nynke Van Den Broek, Zulfiqar A Bhutta

Abstract readEvaluation StudyMeta-AnalysisReview
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in BMC public health, 2011. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 78 papers, 7 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
78citing papers in PubMed, 7 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

78 citing papers in PubMed, 7 syntheses or guidelines pooled it.

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  8. Trial
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  10. The Maternal and Newborn Health Registry Study of the Global Network for Women's and Children's Health Research.International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics · 2012
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  16. Observational
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18 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors.

Mohammad Yawar YakoobDivision of Women and Child Health, The Aga Khan University, Stadium Road, PO Box 3500, Karachi 74800, Pakistan.
Mahrukh Ayesha Ali
Mohammad Usman Ali
Aamer Imdad
Joy E Lawn
Nynke Van Den Broek
Zulfiqar A Bhutta

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

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.

Indexed as

Clinical CompetenceEmergency Medical ServicesObstetricsDelivery, ObstetricFemaleFetal DeathHumansPerinatal MortalityPregnancyRandomized Controlled Trials as TopicStillbirth

Identifiers

PMID21501458
PMCPMC3231913

What OpenQuestion holds

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LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.