Provider-initiated delivery, late preterm birth and perinatal mortality: a secondary analysis of the WHO multicountry survey on maternal and newborn health

Abstract

IntroductionIn high-income countries, a reduced clinical threshold for obstetric interventions such as labour induction (LI) and prelabour caesarean delivery (PLCD) has played a substantial role in increasing rates of late preterm births. However, the association between provider-initiated delivery and perinatal outcomes have not been studied in a multicountry setting including low-income and middle-income countries.Methods286 hospitals in 29 countries participated in the WHO Multi-Country Survey on Maternal and Newborn Health and yielded 2 52 198 singleton births of at least 34 weeks in 2010–2011. We used an ecological analysis based on generalised estimating equations under multilevel logistic regression to estimate associations between hospital rates of PLCD and LI with rates of late preterm birth (34–36 weeks), stillbirth and intrahospital early neonatal death, in relation to country development based on the Human Development Index (HDI).ResultsRates of LI were higher in hospitals from very high-HDI (median 10.9%) and high-HDI (11.2%) countries compared with medium-HDI (4.0%) or low-HDI (3.8%) countries. Rates of PLCD were by far the lowest in low-HDI countries compared with countries in the other three categories (5.1% vs 12.0%–17.9%). Higher rates of PLCD were associated with lower perinatal death rates (OR 0.87 (0.79, 0.95) per 5% increase in PLCD) and non-significantly with late preterm birth (1.04 (0.98, 1.10)) regardless of country development. LI rates were positively associated with late preterm birth (1.04 (1.01, 1.06)) regardless of country development and with perinatal death (1.06 (0.98, 1.15)) only in middle-HDI and low- HDI countries.ConclusionPLCD was associated with reduced perinatal mortality and non-significantly with increased late preterm birth. LI was associated with increases in both late preterm birth and, in less-developed countries, perinatal mortality. Efforts to provide sufficient, but avoid excessive, access to provider-initiated delivery should be tailored to the local context.

Epidemiology of late preterm and early term births – An international perspective

“…In the USA decreases between 2006 and 2014 in providerinitiated deliveries were associated with decreases in late preterm and early term birth [23], but this was not observed in other Nordic countries [23]. In the secondary analysis of the WHO Multi-Country Survey on Maternal and Newborn Health, comprising 29 countries with varying health development index, hospitals with higher labor induction rates had higher risks of late preterm birth [20].…”

“…WHO supported an initiative in 2012 to provide worldwide estimates from 1996 to 2010 and is currently working on more recent estimates for 2014 [1,19]. The WHO Multi-country study is another source for data on preterm births in low-and middle-income countries, although it has a facility-based, as opposed to population-based, design [20]. However, these initiatives have not focused on late preterm or early term births.…”

Como os hospitais universitários estão enfrentando a pandemia de COVID-19 no Brasil?

“…Esta mudança visa a redução do estresse, o apoio, a autoregulação, a promoção de experiências positivas para o recém-nascido (RN), bem como torna a família essencial nos cuidados de rotina. (1,2) No Brasil, o Ministério da Saúde, por meio da Política Nacional de Humanização, estabelece o acolhimento como uma diretriz operacional do processo de trabalho em saúde que requer uma nova atitude, baseado nos pressupostos: protagonismo dos sujeitos envolvidos no processo de produção de saúde; valorização e a abertura para o encontro entre o profissional de saúde e o usuário. Esta diretriz necessita ocorrer em todos os níveis de assistência em saúde.…”

Validação de instrumento de participação da família no cuidado do recém-nascido hospitalizado

“…Esta mudança visa a redução do estresse, o apoio, a autoregulação, a promoção de experiências positivas para o recém-nascido (RN), bem como torna a família essencial nos cuidados de rotina. (1,2) No Brasil, o Ministério da Saúde, por meio da Política Nacional de Humanização, estabelece o acolhimento como uma diretriz operacional do processo de trabalho em saúde que requer uma nova atitude, baseado nos pressupostos: protagonismo dos sujeitos envolvidos no processo de produção de saúde; valorização e a abertura para o encontro entre o profissional de saúde e o usuário. Esta diretriz necessita ocorrer em todos os níveis de assistência em saúde.…”