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 | Â | ||||||||
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 | Â | Very Low** | Low | High | Weak | Weak Against | Weak | Strong: Respiratory Infections |
Interventions given during pregnancy | Â | ||||||||
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 | - | Â | Â | Weak | Â | Â | Â |
Doppler and Late Ultrasound Monitoring | HighNo Effect | Â | - | - | Â | Strong Against | - | - | Â |
Pregnancy infections | Â | ||||||||
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) | Â | 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 | Â | 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 | Â | - | Mod** | Mod** | Low (Maternal Oral Health) | Â | Weak Against | Weak Against | Weak: Maternal Oral Health |
Interventions for pregnancies with high-risks of preterm birth or stillbirth | Â | ||||||||
Progesterone | Mod | Â | High | High | - | Weak Against | Strong | Strong | - |
Cervical Cerclage | HighNo Effect | Â | High No Effect | Â | - | 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 | Â | ||||||||
Birth Preparedness | High | Mod | - | - | Â | Strong | - | - | Â |
Use of Partogram | Low | Low | - | - | Â | Weak | - | - | Â |
Fetal Movement Monitoring | Low | - - | - | - | Â | Strong Against | - | - | Â |
Emergency Obstetric Care | Mod* | Mod* | - | Â | Mod (Maternal Outcomes) | Strong | - | - | Strong: Maternal Mortality |
Cesarean Section for Breech Presentation | - | High | - | - | - | Strong | - | - | Â |
Elective Induction for Post-Term Delivery | Mod | High | - | - | Â | Strong | - | - | Â |
Elective Induction for Term PROM | Â | Mod | Â | Â | High (Maternal and Infant Outcomes) | Weak | Â | Â | Strong: Maternal and Infant Outcomes |
Home Delivery | Â | Mod | - | - | Â | Weak Against | Â | Â | Â |
Intrapartum interventions to improve preterm survival | Â | ||||||||
Prophylactic Steroids in Preterm Labor | - | - | High | - | High(Neonatal Morbidity) | - | Strong | - | Strong: Neonatal Morbidity |
Antibiotics for PROM | - | - | High | - | High(Neonatal Morbidity) | Â | Strong | Â | Strong: Neonatal Morbidity |
Antibiotics for Preterm Labor with Intact Membranes | - | - | High | - | Â | Â | Strong Against | Â | Â |
Delayed cord clamping | Â | Â | High | Â | Â | Â | Strong | Â | Â |
Postnatal interventions to improve preterm survival | Â | ||||||||
Neonatal Resuscitation | Â | Â | Â | Â | Â | Â | Â | Â | Â |
• 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 | Â | Â | Mod | Â | - | Â | Weak | Â | - |
Vitamin A supplementation | Â | Â | Mod | Â | - | Â | Weak Against | Â | - |
Vitamin K supplementation | Â | Â | Mod | Â | Mod (antenatal) | Â | Strong | Â | Weak: antenatal |
Zinc supplementation | Â | Â | Low | Â | - | Â | Weak Against | Â | - |
Selenium supplementation | Â | Â | Mod | Â | - | Â | Weak | Â | - |
Chlorhexidine treatment on the cord | Â | Â | Mod | Â | - | Â | - | Â | - |
Case management of neonatal sepsis and pneumonia | Â | Â | Mod | Â | - | Â | Strong | Â | - |
Kangaroo mother care (KMC) | Â | Â | Â | Â | Â | Â | Â | Â | Â |
Hospital-based KMC | Â | Â | High | Â | - | Â | Strong | Â | - |
Community-based KMC | Â | Â | Low | Â | - | Â | - | Â | - |
Early breastfeeding | Â | Â | High | Â | Mod (neonatal mortality) | Â | Strong | Â | - |
Thermal care (skin to skin; plastic wraps) | Â | Â | Mod | Â | - | Â | Strong | Â | - |
Application of continued distending pressure to the lungs for RDS | Â | Â | High | Â | High (reducing chronic lung disease, and as alternative to intubation) Low pneumothorax | Â | Strong | Â | Strong: bronchopulmonary dysplasia |
Intravenous immune globulin (IVIG) | Â | Â | High | Â | Â | Â | Weak | Â | Â |
Surfactant therapyfor RDS | Â | Â | High | Â | High (reducing chronic lung disease) | Â | Strong | Â | Strong |