Table 2 Studies of the effect of Basic or Comprehensive Emergency Obstetric Care on perinatal-neonatal mortality or intrapartum-related outcomes
Author | Study Years | Setting | Study Design | Intervention definition | Concurrent interventions | Intervention Coverage | Total Births A) Endline B) Baseline | Outcomes | Effect on outcome RR/OR (95% CI) |
|---|---|---|---|---|---|---|---|---|---|
Ronsmans 2010[37] | 1987-2005 | Matlab, Bangladesh | Observational cross-sectional | 1987-1996: skilled home birth care w/midwives providing antenatal care, basic obstetric care (labor monitoring), essential newborn care; 1996 onwards facility based birth with BEmOC (partograph, active management 3rd stage, antibiotics, management preeclampsia). Highest level care received (BEmOC, CEmOC, vs no skilled care) | Antepartum care, Essential newborn care, Strengthening of referral and transport systems | CEmOC 0.5% in 1987 to 11.7% in 2005 BEmOC 4.7% in 1987 to 40.9% in 2005 | CEmOC 3084; BEmOC 9954; No skilled Care 40177 | 1) ENMR 2) Stillbirth | 1)CEmOC aOR 2.69 (2.16-3.37) BEmOC aOR 1.47 (1.27-3.37) 2) CEmOC aOR 6.61(5.62-7.79) BEmOC aOR 1.51(1.31-1.73) |
Berglund 2010[44] | 2003-2004 | 3 Maternity Hospitals; Ukraine | Observational before-after | Training all maternity staff (obstetricians, neonataologists, midwives, anesthesiologists) in 2 week WHO "Effective Perinatal Care" program, including use of partogram, emergency obstetric and neonatal care (resuscitation). | Anesthesia; neonatal resuscitation & special care, thermoregulation | All maternity staff in 3 hospitals | A) 1696 B) 2439 | 1) ENMR | No significant effect |
Hounton | 2001-2005 | Rural Ouargaye and Diapaga districts, Burkina Faso | Quasi-experimental | Upgrading of hospital, health centers in intervention area. Mid-level, referral facilities: emergency obstetric care training. First-level centers: training in prevention of complications and early detection -referral for emergencies. Quality improvement infrastructure upgrading, equipment and supplies | National policies and guidelines; Mobilising/educating communities to plan for and use maternal health services | Training in 1 district hospital and 13/19 health centers | 18,658 births intervention district 2004-5; 21,788 births comparison district 2004-5 | 1) PMR | 1) OR 0.75(0.70-0.80) |
Draycott 2006 [41] | 1998-2003 | South Mead Hospital, UK | Before-after | EOC training course: CTG interpretation, course of action, obstetric emergency drills (dystocia, PPH, eclampsia, twins, breech, resuscitation) | Mandatory course for all midwives | A) 11030 B) 8430 | 1) HIE (MacLennan): | 1) RR 0.50(0.26-0.95) | |
Edmond 2002[42] | 1995-1998 | Natal, Northeast Brazil | Observational before-after | Opening of primary maternity facilities at polyclinic to serve low risk deliveries in the community. Pre-booking of deliveries of high risk pregnancies at Maternity hospital with CEmOC capacity. | ANC, community health agents training in community health clinics | Deliveries at maternity clinics increased from 0% to 51% | A) 536 B) 679 | 1) ENMR 2) Stillbirth 3) PMR | 1) RR 0.12 (0.04-0.40) 2) RR 0.66 (0.47-0.94) 3) RR 0.52 (0.37-0.73) |
McCord 2001[43] | 1996-1999 | Rural Maharashtra, India | Cross-sectional | Comparison of perinatal mortality among births occurring at home vs. in hospital, some with CEmOC | 85% home births, 15% in hospital. | Home: 2436 Hospital: 425 | 1) PMR | PMR 27.1 (home births) vs 87 (hospital deliveries) | |
Koblinsky 1999[40] | 1957-1990s | Malaysia | Historical-ecological | 1960 s Training of professional village midwives, linking to regional clinics, referral to district hospitals; 1980's shift to facility births with BEmOC | 3 decades of perinatal care and obstetric care upgrading | 95% of births by midwives (1996); 80% of risk deliveries in hospital (1998) | NS | 1) NMR | NMR from 75.5 (1957) to 14.8 (1991) |
Korhonen 1994[45] | 1986-1991 | Helsinki, Finland | Cross-sectional | Emergency Caesarean Team in Hospital vs. On call (out of hospital, 10 minute average delay) | NS | 60 in hospital; 41 on call | 1) Fetal Death; 2) HIE | 3 in utero fetal deaths and 1 HIE in control (on-call) group vs 0 hospital | |
Piekkala 1985[1] | 1968-1982 | University Hospital, Turku Finland | Historical | 15 year improvement in obstetric management: Cesearean rate increase from 4-12%; vaginal breech delivery from 4 to 1%; implementation of antepartum CTG (monitoring increase from 0 to 90%) | Corticosteroids, Neonatal intensive care, respiratory therapy, fluid-nutritional therapy | Referral hospital for 10% of population | A) 5,410 B) 5,996 | 1) PMR 2) Intrapartum mortality | 1) RR 0.39 2) RR 0.29 |