Table 3

Summary of assessments for preterm birth and stillbirth interventions (based on GRADE system)

Quality of evidence

Recommendation for Implementation



Intervention

(by stage or recipient)

SB

PMR

PTB

LBW

Other MNCH

Outcomes

SB/PMR

PTB

LBW

Other MNCH

Outcomes


Interventions given before pregnancy

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

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

Doppler and Late Ultrasound Monitoring

HighNo Effect

-

-

Strong Against

-

-

Pregnancy infections

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

Interventions for pregnancies with high-risks of preterm birth or stillbirth

Progesterone

Mod

High

High

-

Weak Against

Strong

Strong

-

Cervical Cerclage

HighNo Effect

High No Effect

-

Weak Against

Strong Against

-

-

Multivitamins for HIV+ Women

Low

Low

Mod No Effect

Mod No Effect

-

Weak Against

Weak Against

Weak Against

-

Intrapartum interventions to prevent stillbirths

Birth Preparedness

High

Mod

-

-

Strong

-

-

Use of Partogram

Low

Low

-

-

Weak

-

-

Fetal Movement Monitoring

Low

- -

-

-

Strong Against

-

-

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

-

-

Elective Induction for Term PROM

Mod

High (Maternal and Infant Outcomes)

Weak

Strong: Maternal

and Infant

Outcomes

Home Delivery

Mod

-

-

Weak Against

Intrapartum interventions to improve preterm survival

Prophylactic Steroids in Preterm Labor

-

-

High

-

High(Neonatal Morbidity)

-

Strong

-

Strong: Neonatal

Morbidity

Antibiotics for PROM

-

-

High

-

High(Neonatal Morbidity)

Strong

Strong: Neonatal

Morbidity

Antibiotics for Preterm Labor with Intact Membranes

-

-

High

-

Strong Against

Delayed cord clamping

High

Strong

Postnatal interventions to improve preterm survival

Neonatal Resuscitation

• Modes of oxygen delivery and resuscitation techniques: CPR

Low

-

-

-

• Modes of delivery and techniques: bag and mask

Mod

-

-

-

• CPR techniques: long- & short-term outcomes

Low

-

-

-

• Room air (vs. 100% oxygen) for resuscitation

High

-

Strong

-

Training programs for health facilities

Mod

-

Weak

-

Vitamin A supplementation

Mod

-

Weak Against

-

Vitamin K supplementation

Mod

Mod (antenatal)

Strong

Weak:

antenatal

Zinc supplementation

Low

-

Weak Against

-

Selenium supplementation

Mod

-

Weak

-

Chlorhexidine treatment on the cord

Mod

-

-

-

Case management of neonatal sepsis and pneumonia

Mod

-

Strong

-

Kangaroo mother care (KMC)

Hospital-based KMC

High

-

Strong

-

Community-based KMC

Low

-

-

-

Early breastfeeding

High

Mod (neonatal mortality)

Strong

-

Thermal care (skin to skin; plastic wraps)

Mod

-

Strong

-

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

Intravenous immune globulin (IVIG)

High

Weak

Surfactant therapyfor RDS

High

High (reducing chronic lung disease)

Strong

Strong


(*) Due to ethical issues, RCTs are not possible.

(**) Limited evidence, or outcomes not reported.

(-) Not applicable or no evidence

Barros et al. BMC Pregnancy and Childbirth 2010 10(Suppl 1):S3   doi:10.1186/1471-2393-10-S1-S3

Open Data