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Int J Gynaecol Obstet. 2009 Oct;107 Suppl 1:S21-44, S44-5. doi: 10.1016/j.ijgo.2009.07.017.

Obstetric care in low-resource settings: what, who, and how to overcome challenges to scale up?

Author information

1
Effective Care Research Unit, Eastern Cape Department of Health, Universities of the Witwatersrand and Fort Hare, South Africa. gjh@global.co.za

Abstract

BACKGROUND:

Each year, approximately 2 million babies die because of complications of childbirth, primarily in settings where effective care at birth, particularly prompt cesarean delivery, is unavailable.

OBJECTIVE:

We reviewed the content, impact, risk-benefit, and feasibility of interventions for obstetric complications with high population attributable risk of intrapartum-related hypoxic injury, as well as human resource, skill development, and technological innovations to improve obstetric care quality and availability.

RESULTS:

Despite ecological associations of obstetric care with improved perinatal outcomes, there is limited evidence that intrapartum interventions reduce intrapartum-related neonatal mortality or morbidity. No interventions had high-quality evidence of impact on intrapartum-related outcomes in low-resource settings. While data from high-resource settings support planned cesarean for breech presentation and post-term induction, these interventions may be unavailable or less safe in low-resource settings and require risk-benefit assessment. Promising interventions include use of the partograph, symphysiotomy, amnioinfusion, therapeutic maneuvers for shoulder dystocia, improved management of intra-amniotic infections, and continuous labor support. Obstetric drills, checklists, and innovative low-cost devices could improve care quality. Task-shifting to alternative cadres may increase coverage of care.

CONCLUSIONS:

While intrapartum care aims to avert intrapartum-related hypoxic injury, rigorous evidence is lacking, especially in the settings where most deaths occur. Effective care at birth could save hundreds of thousands of lives a year, with investment in health infrastructure, personnel, and research--both for innovation and to improve implementation.

PMID:
19815204
DOI:
10.1016/j.ijgo.2009.07.017
[Indexed for MEDLINE]

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