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Table 3 Summary of assessments for preterm birth and stillbirth interventions (based on GRADE system)

From: Global report on preterm birth and stillbirth (3 of 7): evidence for effectiveness of interventions

  

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

  1. (*) Due to ethical issues, RCTs are not possible.
  2. (**) Limited evidence, or outcomes not reported.
  3. (-) Not applicable or no evidence