Reducing intrapartum-related deaths and disability: Can the health system deliver?

Joy E. Lawn, Mary Kinney, Anne C C Lee, Mickey Chopra, France Donnay, Vinod K. Paul, Zulfiqar A. Bhutta, Massee Bateman, Gary L. Darmstadt

Research output: Contribution to journalArticle

Abstract

Background: Each year 1.02 million intrapartum stillbirths and 904 000 intrapartum-related neonatal deaths (formerly called "birth asphyxia") occur, closely linked to 536 000 maternal deaths, an estimated 42% of which are intrapartum-related. Objective: To summarize the results of a systematic evidence review, and synthesize actions required to strengthen healthcare delivery systems and home care to reduce intrapartum-related deaths. Methods: For this series, systematic searches were undertaken, data synthesized, and meta-analyses carried out for various aspects of intrapartum care, including: obstetric care, neonatal resuscitation, strategies to link communities with facility-based care, care within communities for 60 million non-facility births, and perinatal audit. We used the Lives Saved Tool (LiST) to estimate neonatal deaths prevented with relevant interventions under 2 scenarios: (1) to address missed opportunities for facility and home births; and (2) assuming full coverage of comprehensive emergency obstetric care and emergency newborn care. Countries were first grouped into 5 Categories according to level of neonatal mortality rate and examined, and then priorities were suggested to reduce intrapartum-related deaths for each Category based on health performance and possible lives saved. Results: There is moderate GRADE evidence of effectiveness for the reduction of intrapartum-related mortality through facility-based neonatal resuscitation, perinatal audit, integrated community health worker packages, and community mobilization. The quality of evidence for obstetric care is low, requiring further evaluation for effect on perinatal outcomes, but is expected to be high impact. Over three-quarters of intrapartum-related deaths occur in settings with weak health systems marked by low coverage of skilled birth attendance (

Original languageEnglish (US)
JournalInternational Journal of Gynecology and Obstetrics
Volume107
Issue numberSUPPL.
DOIs
Publication statusPublished - Oct 2009

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Keywords

  • Birth asphyxia/asphyxia neonatorum
  • Health systems
  • Intervention
  • Intrapartum-related neonatal mortality
  • Lives saved
  • Neonatal mortality
  • Prevention
  • Stillbirth
  • Systematic review

ASJC Scopus subject areas

  • Obstetrics and Gynecology
  • Medicine(all)

Cite this

Lawn, J. E., Kinney, M., Lee, A. C. C., Chopra, M., Donnay, F., Paul, V. K., ... Darmstadt, G. L. (2009). Reducing intrapartum-related deaths and disability: Can the health system deliver? International Journal of Gynecology and Obstetrics, 107(SUPPL.). https://doi.org/10.1016/j.ijgo.2009.07.021