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Acta Obstet Gynecol Scand. 2013 May;92(5):496-507. doi: 10.1111/aogs.12071. Epub 2013 Feb 12.

Responsiveness of emergency obstetric care systems in low- and middle-income countries: a critical review of the "third delay".

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Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.


We reviewed the evidence on the duration, causes and effects of delays in providing emergency obstetric care to women attending health facilities (the third delay) in low- and middle-income countries. We performed a critical literature review using terms related to obstetric care, birth outcome, delays and developing countries. A manual search of reference lists of key articles was also performed. 69 studies met the inclusion criteria. Most studies reported long delays in providing care, and the mean waiting time for women admitted with complications was as much as 24 h before treatment. The three most cited barriers to providing timely care were shortage of treatment materials, surgery facilities and qualified staff. Existing evidence is insufficient to estimate the effect of delays on birth outcomes. Delays in providing emergency obstetric care seem common in resource-constrained settings but further research is necessary to determine the effect of the third delay on birth outcomes.

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