Table 3 |
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Summary of assessments for preterm birth and stillbirth interventions (based on GRADE system) |
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Quality of evidence |
Recommendation for Implementation |
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|
|
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|
Intervention (by stage or recipient) |
SB |
PMR |
PTB |
LBW |
Other MNCH Outcomes |
SB/PMR |
PTB |
LBW |
Other MNCH Outcomes |
|
|
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|
Interventions given before pregnancy |
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|
Birth Spacing |
Low |
Mod |
Mod* |
Mod* |
Mod* |
Weak |
Weak |
Weak |
Strong: Maternal and Child Mortality |
|
Periconceptional Folate |
Mod |
Mod |
Low |
Low |
High |
Weak Against |
Weak |
Weak |
Strong: Neural Tube Defects |
|
Indoor Air Pollution Control |
Low |
Very Low** |
Low |
High |
Weak |
Weak Against |
Weak |
Strong: Respiratory Infections |
|
|
Interventions given during pregnancy |
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Smoking Cessation Programs |
Low |
Low |
High |
High |
High |
Weak |
Strong |
Strong |
Strong: Smoking-Related Diseases |
|
Balanced Protein Energy Supplementation |
High |
- |
HighNo Effect |
High |
- |
Strong |
Strong Against |
Strong |
Strong: Infant Mortality |
|
Multiple Micronutrient Supplementation |
High No Effect |
Mod |
HighNo Effect |
High |
High (Maternal Anemia, I MR) |
Weak Against |
Strong Against |
Strong |
Weak Against: Neonatal Mortality |
|
Iron and Folate Supplementation |
Mod No Effect** |
Mod No Effect** |
Mod No Effect** |
Mod No Effect** |
High (Maternal Anemia) |
Weak Against |
Weak Against |
Weak Against |
Strong: Anemia |
|
Zinc Supplementation |
HighNo Effect |
HighNo Effect |
High High |
HighNo Effect |
Mod (Reduced C-Sections) |
Strong Against |
Weak |
Strong Against |
Weak |
|
Magnesium Sulfate Supplementation |
High |
High |
Mod** |
Mod** |
High(Cerebral Palsy) |
Strong Against |
Weak Against |
Weak Against |
Weak: Supplementation Strong: Treatment of Eclampsia and Prevention of Cerebral Palsy |
|
Calcium Supplementation |
HighNo Effect |
- |
Mod |
Mod |
High (Preeclampsia) |
Strong Against |
Weak |
Weak |
Strong: Preeclampsia |
|
Supplementation with Fatty Acids |
- |
- |
HighNo Effect |
HighNo Effect |
- |
- |
Strong Against |
Strong Against |
- |
|
Cardiotocographic Monitoring |
Low |
Mod |
- |
Weak |
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Doppler and Late Ultrasound Monitoring |
HighNo Effect |
- |
- |
Strong Against |
- |
- |
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Pregnancy infections |
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Screening and Treatment of Syphilis |
Mod* |
Very Low** |
Mod* |
Mod* |
Mod* |
Strong |
Weak |
Weak |
Strong: Congenital Syphilis |
|
Intermittent Presumptive Treatment During Pregnancy (IPTp) for malaria |
Mod |
High |
Low** |
High |
High |
Strong |
Weak |
Strong |
Strong: Maternal Malaria |
|
Insecticide-Treated Mosquito Nets (ITNs) |
High |
- |
Low** |
High |
High |
Strong |
Weak Against |
Strong |
Strong: Maternal Malaria |
|
Screening and Treatment of Asymptomatic Bacteriuria |
** |
** |
Low** |
High |
High (Maternal Morbidity) |
Weak |
Strong |
Strong: Pyelonephritis, Maternal Morbidity |
|
|
Screening and Treatment of Bacterial Vaginosis |
- |
- |
HighNo Effect |
HighNo Effect |
- |
- |
Strong Against |
Strong Against |
- |
|
Prevention of Mother-to- Child Transmission of HIV |
Low |
Low |
Low |
High (PMTCT) |
** |
** |
** |
Strong: PMTCT |
|
|
Anti-Helminthic Treatment |
Low |
Low |
Low |
Low |
High (Maternal Hookworm) |
Weak Against |
Weak Against |
Weak Against |
Strong: Maternal Anemia |
|
Screening and Treatment of Periodontal Disease |
- |
Mod** |
Mod** |
Low (Maternal Oral Health) |
Weak Against |
Weak Against |
Weak: Maternal Oral Health |
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Interventions for pregnancies with high-risks of preterm birth or stillbirth |
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|
Progesterone |
Mod |
High |
High |
- |
Weak Against |
Strong |
Strong |
- |
|
|
Cervical Cerclage |
HighNo Effect |
High No Effect |
- |
Weak Against |
Strong Against |
- |
- |
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Multivitamins for HIV+ Women |
Low |
Low |
Mod No Effect |
Mod No Effect |
- |
Weak Against |
Weak Against |
Weak Against |
- |
|
Intrapartum interventions to prevent stillbirths |
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|
Birth Preparedness |
High |
Mod |
- |
- |
Strong |
- |
- |
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Use of Partogram |
Low |
Low |
- |
- |
Weak |
- |
- |
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Fetal Movement Monitoring |
Low |
- - |
- |
- |
Strong Against |
- |
- |
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Emergency Obstetric Care |
Mod* |
Mod* |
- |
Mod (Maternal Outcomes) |
Strong |
- |
- |
Strong: Maternal Mortality |
|
|
Cesarean Section for Breech Presentation |
- |
High |
- |
- |
- |
Strong |
- |
- |
|
|
Elective Induction for Post-Term Delivery |
Mod |
High |
- |
- |
Strong |
- |
- |
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Elective Induction for Term PROM |
Mod |
High (Maternal and Infant Outcomes) |
Weak |
Strong: Maternal and Infant Outcomes |
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Home Delivery |
Mod |
- |
- |
Weak Against |
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Intrapartum interventions to improve preterm survival |
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|
Prophylactic Steroids in Preterm Labor |
- |
- |
High |
- |
High(Neonatal Morbidity) |
- |
Strong |
- |
Strong: Neonatal Morbidity |
|
Antibiotics for PROM |
- |
- |
High |
- |
High(Neonatal Morbidity) |
Strong |
Strong: Neonatal Morbidity |
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Antibiotics for Preterm Labor with Intact Membranes |
- |
- |
High |
- |
Strong Against |
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Delayed cord clamping |
High |
Strong |
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Postnatal interventions to improve preterm survival |
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Neonatal Resuscitation |
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|
• Modes of oxygen delivery and resuscitation techniques: CPR |
Low |
- |
- |
- |
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• Modes of delivery and techniques: bag and mask |
Mod |
- |
- |
- |
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• CPR techniques: long- & short-term outcomes |
Low |
- |
- |
- |
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|
• Room air (vs. 100% oxygen) for resuscitation |
High |
- |
Strong |
- |
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Training programs for health facilities |
Mod |
- |
Weak |
- |
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Vitamin A supplementation |
Mod |
- |
Weak Against |
- |
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|
Vitamin K supplementation |
Mod |
Mod (antenatal) |
Strong |
Weak: antenatal |
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Zinc supplementation |
Low |
- |
Weak Against |
- |
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Selenium supplementation |
Mod |
- |
Weak |
- |
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Chlorhexidine treatment on the cord |
Mod |
- |
- |
- |
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Case management of neonatal sepsis and pneumonia |
Mod |
- |
Strong |
- |
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Kangaroo mother care (KMC) |
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|
Hospital-based KMC |
High |
- |
Strong |
- |
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|
Community-based KMC |
Low |
- |
- |
- |
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|
Early breastfeeding |
High |
Mod (neonatal mortality) |
Strong |
- |
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|
Thermal care (skin to skin; plastic wraps) |
Mod |
- |
Strong |
- |
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Application of continued distending pressure to the lungs for RDS |
High |
High (reducing chronic lung disease, and as alternative to intubation) Low pneumothorax |
Strong |
Strong: bronchopulmonary dysplasia |
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Intravenous immune globulin (IVIG) |
High |
Weak |
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|
Surfactant therapyfor RDS |
High |
High (reducing chronic lung disease) |
Strong |
Strong |
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(*) Due to ethical issues, RCTs are not possible. (**) Limited evidence, or outcomes not reported. (-) Not applicable or no evidence |
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|
Barros et al. BMC Pregnancy and Childbirth 2010 10(Suppl 1):S3 doi:10.1186/1471-2393-10-S1-S3 |
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