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