Stillbirths – A Global Review of Interventions and Risk Factors

Stillbirths – A Global Review of Interventions and Risk Factors

 

Zulfiqar Bhutta, of the Aga Khan University, Karachi, Pakistan presented a systematic review of the burden and interventions for the reduction of stillbirths in developing countries. The review was conducted by him and colleagues (Figure 1.1).

 

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Dr. Bhutta pointed out the limitations on obtaining meaningful information (
Figure 1.2). However the review had specific aims (Figure 1.3). The methodology consisted of a comprehensive search of the literature and classification of the evidence in those articles. This approach is described in Figures 1.4, 1.5, 1.6, 1.7, 1.8, 1.9.

 

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Dr. Bhutta described an interesting study of the use of the verbal autopsy in three communities in
Pakistan. This very large study is described in Figures 1.10, 1.11, 1.12, 1.13, 1.14, 1.15, 1.16, 1.17. The study shows that in these districts the majority (66%) of stillbirths are “fresh” i.e. intrapartum deaths. The study is now being complemented with the nationwide DHS survey which also includes evaluation of the causes of stillbirths.

 

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An overview of the studies which were examined in the literature review is shown in
Figure 1.18.

 

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Antenatal care (Figure 1.19)

 

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Fetal movement monitoring (
Figure 1.20)

 

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Training community midwives (
Figure 1.21)

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Birth assistance by trained birth attendant (Figure 1.22)

 

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Training traditional birth attendants (Figure 1.23)

 

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Importance of quality of antenatal care (
Figure 1.24)

 

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Effect of quantum of antenatal care (
Figure 1.25)

 

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Maternity waiting homes for high risk/remote deliveries (
Figure 1.26)

 

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Syphilis screening and treatment (
Figure 1.27)

 

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Conclusions are outlined in
Figures 1.28, 1.29, 1.30, 1.31 and indicate that while much of the evidence base for reducing stillbirths derives from institution-based interventions, there is evidence that community strategies geared towards promoting care seeking and skilled attendance also have a positive impact on reducing stillbirths and improving perinatal outcomes.

 

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