Abstract:
BACKGROUND:In 2001, the WHO Antenatal Care Trial (WHOACT) concluded that an antenatal care package of evidence-based screening, therapeutic interventions and education across four antenatal visits for low-risk women was not inferior to standard antenatal care and may reduce cost. However, an updated Cochrane review in 2010 identified an increased risk of perinatal mortality of borderline statistical significance in three cluster-randomized trials (including the WHOACT) in developing countries. We conducted a secondary analysis of the WHOACT data to determine the relationship between the reduced visits, goal-oriented antenatal care package and perinatal mortality. METHODS:Exploratory analyses were conducted to assess the effect of baseline risk and timing of perinatal death. Women were stratified by baseline risk to assess differences between intervention and control groups. We used linear modeling and Poisson regression to determine the relative risk of fetal death, neonatal death and perinatal mortality by gestational age. RESULTS:12,568 women attended the 27 intervention clinics and 11,958 women attended the 26 control clinics. 6,160 women were high risk and 18,365 women were low risk. There were 161 fetal deaths (1.4%) in the intervention group compared to 119 fetal deaths in the control group (1.1%) with an increased overall adjusted relative risk of fetal death (Adjusted RR 1.27; 95% CI 1.03, 1.58). This was attributable to an increased relative risk of fetal death between 32 and 36 weeks of gestation (Adjusted RR 2.24; 95% CI 1.42, 3.53) which was statistically significant for high and low risk groups. CONCLUSION:It is plausible the increased risk of fetal death between 32 and 36 weeks gestation could be due to reduced number of visits, however heterogeneity in study populations or differences in quality of care and timing of visits could also be playing a role. Monitoring maternal, fetal and neonatal outcomes when implementing antenatal care protocols is essential. Implementing reduced visit antenatal care packages demands careful monitoring of maternal and perinatal outcomes, especially fetal death.
journal_name
Reprod Healthjournal_title
Reproductive healthauthors
Vogel JP,Habib NA,Souza JP,Gülmezoglu AM,Dowswell T,Carroli G,Baaqeel HS,Lumbiganon P,Piaggio G,Oladapo OTdoi
10.1186/1742-4755-10-19subject
Has Abstractpub_date
2013-04-12 00:00:00pages
19issn
1742-4755pii
1742-4755-10-19journal_volume
10pub_type
杂志文章,随机对照试验abstract:BACKGROUND:Historically, transitioning gender was seen as precluding transgender people from having children in the future. However, there are now increased reproductive options available to transgender people, with such options also available to non-binary people (i.e., people whose gender is not exclusively male or f...
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pub_type: 杂志文章
doi:10.1186/s12978-018-0627-z
更新日期:2018-10-25 00:00:00
abstract:BACKGROUND:Adolescent pregnancy is a worldwide problem because of its health, social, economic and political repercussions on the globe. Even though the rates of adolescent pregnancy have declined over the decade, there is still unacceptably high rates especially in lower and middle-income countries including Ghana. Al...
journal_title:Reproductive health
pub_type: 杂志文章,随机对照试验
doi:10.1186/s12978-019-0784-8
更新日期:2019-08-15 00:00:00
abstract:BACKGROUND:As per the World Health Organization, the nutritional status of women of reproductive age is important, as effects of undernutrition are propagated to future generations. More than one-third of Indian women in the reproductive age group are in a state of chronic nutritional deficiency during the preconceptio...
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doi:10.1186/s12978-018-0535-2
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abstract:BACKGROUND:Adolescents 360 (A360) is an initiative being rolled out across Ethiopia, Nigeria and Tanzania with the aim of increasing uptake of voluntary modern contraception among sexually active women aged 15 to 19 years. Using evaluation baseline survey data, we described key sexuality, fertility and contraceptive us...
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doi:10.1186/s12978-019-0666-0
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abstract:BACKGROUND:Recent studies have demonstrated that it is common for women to report inconsistent fertility motivations and family planning behaviors. This study examines these inconsistencies among urban Honduran women interviewed at two points in time and presents reasons for inconsistent fertility motivations and contr...
journal_title:Reproductive health
pub_type: 杂志文章
doi:10.1186/1742-4755-6-19
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abstract::The ICPD agenda of reproductive health was declared as the most comprehensive one, which had actually broadened the spectrum of reproductive health and drove the states to embark upon initiatives to improve reproductive health status of their populations. However, like all other countries, Pakistan also seems to have ...
journal_title:Reproductive health
pub_type: 杂志文章
doi:10.1186/1742-4755-5-4
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abstract::District level healthcare serves as a nexus between community and district level facilities. Inputs at the district level can be broadly divided into governance and accountability mechanisms; leadership and supervision; financial platforms; and information systems. This paper aims to evaluate the effectivness of distr...
journal_title:Reproductive health
pub_type: 杂志文章,评审
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journal_title:Reproductive health
pub_type: 杂志文章
doi:10.1186/s12978-016-0192-2
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abstract:BACKGROUND:Improving the reproductive health of young women in developing countries requires access to safe and effective methods of fertility control, but most rely on traditional rather than modern contraceptives such as condoms or oral/injectable hormonal methods. We conducted a systematic review of qualitative rese...
journal_title:Reproductive health
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doi:10.1186/1742-4755-6-3
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pub_type: 杂志文章,随机对照试验
doi:10.1186/s12978-015-0057-0
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journal_title:Reproductive health
pub_type: 杂志文章
doi:10.1186/1742-4755-7-12
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abstract:BACKGROUND:Maternal mortality in South Africa is high and a cause for concern especially because the bulk of deaths from maternal causes are preventable. One of the proposed reasons for persistently high maternal mortality is HIV which causes death both indirectly and directly. While there is some evidence for the impa...
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journal_title:Reproductive health
pub_type: 杂志文章,多中心研究
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pub_type: 杂志文章,多中心研究
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journal_title:Reproductive health
pub_type: 杂志文章
doi:10.1186/1742-4755-10-59
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更新日期:2019-08-19 00:00:00
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更新日期:2017-03-11 00:00:00
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journal_title:Reproductive health
pub_type: 杂志文章,随机对照试验
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更新日期:2011-01-17 00:00:00
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journal_title:Reproductive health
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journal_title:Reproductive health
pub_type: 杂志文章
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更新日期:2016-06-08 00:00:00
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更新日期:2011-01-05 00:00:00
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journal_title:Reproductive health
pub_type: 杂志文章
doi:10.1186/s12978-016-0275-0
更新日期:2017-01-14 00:00:00